18 May 2006

Cheap Health Fixes

The Partnership For Prevention, a non-profit sponsored by a coalition of health insurers has released a ranking of twenty-five relatively inexpensive preventative health care options based upon the aggregate number of years of quality life that would be added to American's lives by widespread use of each technique, and third party rankings of their value.

Yes, this study, like any industry funded study has biases. But, like most insurance contracts, the health insurer-insured relationship is set up so that you get the most out of it if bad things happen to you, while the insurance company does best (in the form of fewer claims) if bad things don't happen to you. Also, like most statistics the issue is not that they aren't true (they are derived from to other nono-profits were more pure motives), but that they are incomplete. The study does not, for example, compare the benefits of cheap preventative approaches, to the benefits of expensive interventions which may also be extremely valuable to patients, particularly when viewed as individuals facing life or death decisions, rather than in the aggregate.

So, onto the results. There are three undisputed winners of the twenty-five prevention options identified.

#1 Low dose daily asprin regimes for men aged 40+, women aged 50+, and others at risk of cardiovascular diseases. This is the runaway favorite of all of the methods. If used by 90% of the target population is would save 1.3 million quality years of life. It is cheap, yet extremely effective. It has few downsides. It impacts a huge population.

#2 Childhood immunizations. A half a dozen days of shots over several years have an immense positive health effect.

#3 Tobacco Screening. Screening adults for tobacco use and providing brief counseling and referrals for drug treatments to help users quit has a very big rate of return. Why? Tobacco use dramatically increases your risk of serious health problems, so even if only a small percentage of those told to quit by their doctors do so, the rewards are very high.

In the next tier are colorectal cancer screening for adults age 50+, hypertension screening, annual flu shots for those aged 50+, pneumonia shots for those age 65+, problem drinking screening and brief referrals for counseling, and vision screening for those age 65+.

Colorectoral cancer is very deadly because it doesn't lead to symptoms that can be discerned without clinical tests until it is well advanced. Hypertension screening allows people to get preventive care for a leading cause of death before it is too late. Immuninizations are vital for the old who have more fragile immune systems. The rational for problem drinking screening is similar to that for tobacco use. And, vision screening can prevent car accidents and other problems that arise from undiagnosed declining vision.

Rounding out the top of the list are pap smears for all women age 21+ and all sexually active women, cholesterol screening for men age 35+ and women age 45+, breast cancer screening for women age 50+ (and considered for women age 40+), chlamydia screening for sexually active women age 25 and under, calcium supplements for adolescent and adult women (to prevent osteoperosis), and vision screening for children under five.

Next in line were folic acid supplements for women of child bearing age (to prevent birth defects), and obesity screening accompanied by intense diet and exercise counseling.

More moderately effective were depression screening for adults with followup, hearing screening for adults age 65+, injury prevention counseling for parents of children under five, osteoperosis screening for women age 65+ and high risk women age 60+.

The least effective preventive measures on an admittedly already selective list of twenty-five proven prevention methods were cholestoral screening for younger adults with risk factors for heart disease, diabetes screening, diet counseling for non-obese patients with other risk factors, and tetanus shot boosters every ten years.

Still, since all of the techniques on the list have proven clinical value and are inexpensive, there is no reason that all of them shouldn't be routine. Other than an asprin regime, the entire list of preventative services can be summed up in just one action item. Get an annual physical with your doctor and follow doctor's orders if there are any. Then the doctors can keep track of what needs to be done.

One doctor's visit a year isn't that expensive (although follow up may be, if, for example, you learn that you have cancer and don't currently have health insurance, creating a pre-existing condition that may limit your ability to get care once you get health insurance) and it can add years to your life.

While I'm at it, I'll highlight a recent JAMA study referenced by Creative Destruction, that notes that while obesity is a major health risk, that the health risk from obesity is more concentrated that had originally been believed, in that merely being "overweight", as oppposed to "obese" isn't a problem and may even be a good thing.

[A] recent JAMA study, written by Katherine Flegal and colleagues, which found that being mildly “overweight” is in fact associated with a longer lifespan than being the so-called “normal” weight, and that overall only 25,000 “extra” deaths per year are caused by obesity and overweight combined. (That’s actually over 110,000 obesity-related deaths, minus the deaths “saved” per year because overweight people live longer than “normal” weight people).

The study also showed the obesity risk was concentrated in those with body mass indexes of 35+. (I'm wouldn't I'd take the reporting bloggers comments not directly from the study as far as the linked blogger does, however).

1 comment:

Andrew Oh-Willeke said...

For a personal take on the importance of pap smears, listen to Evil Mommy's account.