I recently came across a paper that was published almost ten years ago (2017) but which I think is highly relevant and very interesting. But before I get into it, let me give a bit of context.
Many people assume that the lack of pro-active testing for every possible problem in medicine is simply done as a cost savings measure. Patients will sometimes complain to me that their insurance won’t cover a periodic full-body MRI, or a routine stress test, or blood testing in the absence of any symptoms for this disease or that. And there is some validity to this critique: it’s certainly true that insurers like to spend as little money as possible on patients. But to be fair, there is another side to the argument, which is that – contrary to what many assume – testing for problems that aren’t apparent can sometimes in fact be harmful.
This is a difficult topic to grasp, so I’m going to break this post down into two parts. Today, I will outline some of the logic behind why tests can sometimes create more problems than they prevent. In next week’s post, I will give a few actual anecdotes from my career that demonstrate the point.
How could it possibly be that ordering tests to screen for health problems can be harmful?
I met a new patient recently who was quite concerned about his cholesterol after his last doctor suggested he go on a statin. After discussing this patient’s medical history and reviewing his labs, it became obvious that he does NOT have a cholesterol problem, and certainly not one that warrants medication. This is a common scenario I run into in clinical practice, so I thought it would be useful to take a few minutes to run through some of the thought processes that a doctor should take when evaluating a patient’s cholesterol.
Without further ado, let’s delve in. Here are a few key points that are important to understand when thinking about cholesterol. Read through them, and then I’ll come back to the patient.
In recent years, there has been an explosion of interest in healthcare related content on the internet. Podcasts by figures such as Peter Attia, Andrew Huberman, Rhonda Patrick, Ken Berry, and Gabrielle Lyon, to name a few, have become extremely popular. Typically these podcasts take a health issue and dissect it for the average person, often with a bit of a different perspective than is found in mainstream medicine. And while I don’t agree with every single thing that each of the above doctors says or touts, I think that overall these folks do a great service to the American (and global) public by empowering people to learn more about how to take charge of their own health.
I am proud to announce that, several months after ordering it, our Styku body composition scanner arrived last week and is now operational. Starting immediately, my patients can regularly have painless, non-invasive, radiation free body scans here in the office that will provide them with key information about their metabolic health and their risk for developing chronic diseases such as diabetes, hypertension, and cancer, as well as feedback about weight loss and fitness efforts.
Tens of millions of Americans suffer from insulin resistance, and most of them don’t even know it. Left unchecked, insulin resistance can lead to heart disease, cancer, dementia, type 2 diabetes, high blood pressure, and lots of other bad health outcomes. But before I can get into explaining how you can know if you have this condition, and what you can do about it if you do, I first need to explain what insulin resistance is.
