This week’s Health Wonk Review included an excellent post by Gary Schwitzer, addressing a recent article in Prevention Magazine about high-tech screening tests for heart disease. Gary notes that the Prevention article over-recommends many of the tests for healthy, asymptomatic individuals. In addition, their three example stories about women who “didn’t think they were at high risk” for heart attack included one woman who was morbidly obese (5’4″ and 245 pounds) and another who was borderline obese when their heart attacks occurred. Perhaps they didn’t realize this put them at a higher risk of cardiovascular disease – including heart attack – but it seems a bit irresponsible to use their stories to push for advanced cardiac testing on all healthy (and presumably healthy weight) people.
Some of these tests are not cheap. The Cleveland Clinic will do a Calcium score screening for $340, and notes that the procedure is not covered by Medicare or most health insurance policies. The University of Chicago Medical Center charges $325 for the Carotid Intima Media Thickness test, which is also not covered by Medicare or most health insurance plans. (One has to wonder whether health insurers will eventually end up providing coverage for these tests via new mandates. If they do, the result will be increased premiums for all of us.) In cases where a patient is at an elevated risk for heart disease and the testing is recommended by evidence-based medicine, these costs are a small price to pay for possibly preventing a heart attack (it’s worth noting that just having the tests will do nothing to prevent a heart attack. Once getting the results, the patient will have to be compliant with preventive treatment, which should include lifestyle modification). But recommending advanced testing for people at low risk is backpedaling from the focus we need to have, which should be on reducing health care costs and over-consumption of care. In addition to the cost of the testing, more patients will likely end up on various prescription drugs as a result of the testing, which further increases healthcare costs. And it’s worth remembering that sometimes drugs do more harm than good – but we rarely notice that without the benefit of hindsight.
It’s easy to say that a few hundred dollars for a test (or a few thousand dollars if people opt to get multiple tests) is far less expensive than the cost of a heart attack. But Prevention’s advice takes things a bit too far: “If you have not had these cutting edge screenings, put this magazine down and call your doctor. Now” How many false positives would be detected if everyone (including those who are truly low-risk) followed their advice? How much money would be spent on health care in the form of testing and additional prescription drugs in order to prevent one heart attack? We seem to be caught up in a wave of screening test excitement lately, with new advanced testing available for every disease under the sun. Rather than focusing on things that can truly prevent health problems (the old, and decidedly low-tech diet and exercise ideas…), we are fixated on developing newer and better screening tests. This exacerbates the problem of over-consumption of health care and rising health care costs.