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In the US, my experience has largely been that it's not healthcare, it's sickcare. Wait until sick, get treated. Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky, and then a "you look great see you next year", aka, come back when you're sick.

I spent the last few years seeking proactive healthcare and the "system" is very much stacked against you. If you're fortunate enough to have the resources to push through, you can get all sorts of stuff done -- broader blood panels, body scans (eg. Prenuvo), VO2 max, metals tests, mold tests, genetic tests, GI tests, etc etc. But these are luxuries and if you ask most doctors, you'll get back "you look great why would you do that?", aka, come back when you're sick.

A friend of mine in the middle east says you can do all that for almost nothing by walking into any hospital, but it's subsidized by government (oil) dollars.

[edit] Reading more of the comments this seems par for the course in many "wealthy" countries.

5 comments

None of those things are necessary most of the time, and they’re usually just going to make you paranoid. It’s why doctors don’t generally like to do full-body scans on healthy people: they’re rarely going to find anything clinically significant, but they’re often going to find something that causes a scare and some unnecessary tests. (And if the scan is a CT scan, on average, the radiation may cause more cancers than it catches if you’re scanning healthy people for no reason.)

If you want to have the best shot at preventing disease and living a long, healthy life, it’s not complicated: eat a healthy diet, exercise, get a good night’s sleep, avoid drugs and alcohol, and have fulfilling relationships with other people. Beyond that, you’re spending a lot of money on things that are going to have a negligible or even negative impact on your health and quality of life.

I did a CT scan recently for something unrelated which found some soft tissue lesion in the thymus. Cue doctors trying to tell me that I should just remove the thymus since it's not possible to do a biopsy and anyway the thymus is useless. Read recent research in NJEM that shows that removing the thymus increases risks of getting cancer and that it's anything but benign.

Eventually, I did a PET scan, got second opinions (that think it's most likely hyperplasia), determined that given the result of the PET scan, I don't have carcinoma or anything that is likely to be fast progressing. So, I won't operate, I will do regular MRIs to check the progress and monitor that it's not anything.

All this to say, that yes, having that result mostly caused additional stress for something that is actually likely to have already been there for years and years.

Understanding the results does take education, I agree with that, but having more data over time seems much better than flying blind and then being surprised when something actually does happen.

If getting that extra data imposes a risk (eg. radiation) then the tradeoff is not so simple.

ya agree there. but most of those things aren't tradeoffs, aside from a bit of time and money (both of which go back to my original point about why I think the system is not working)

People in high risk categories are warranted to go further than that

Sure, but most people are by definition not high risk.

> But these are luxuries and if you ask most doctors, you'll get back "you look great why would you do that?", aka, come back when you're sick.

Proactive tests are great! Except for the false positive challenge. If the test has a 99% accuracy and it detects a problem that presents in 0.1% (1 in 1000) of general population, do you have the issue? Should you do something about it?

Well it turns out you only have a 3% (my math is likely imperfect) chance of actually having the thing you tested for unless you also have other symptoms. Now what do you do about it? Unnecessary medical interventions kill people all the time.

Prostate cancer is a great example here. If you’re over 30 and male, you very likely have a little bit of detectable prostate cancer. But you’re fine just leaving it alone for another 30 years and there’s a huge likelihood it’s never going to become a problem at all. Getting it fixed would be way worse for you than leaving it alone. (1 in 8 men eventually gets diagnosed with this meaning way more actually have it)

It's funny that we only apply this "more data = bad" logic to things that aren't readily visible.

If you have a palpable or visible likely-benign condition that isn't causing symptoms, such as a mole, rash, or lump, every doctor will recommend getting that checked out. Most of the time it'll turn out to be completely innocuous, but you'll go to the doctor and they'll decide between it's fine, monitoring, invasive investigation, and urgent treatment.

Obviously if the test itself is invasive (e.g. has a dose of radiation) then that is something that needs to be compared against the potential benefit. I certainly would not have a preventative head CT scan.

However if we're talking about things like an MRI, urine/stool test, or even something like a blood panel that has extremely low risks for most apparently healthy people (I donate blood 6x a year anyway - why not take some of that and test it), then why is it so different to a skin check, besides the cost?

> Obviously if the test itself is invasive (e.g. has a dose of radiation) then that is something that needs to be compared against the potential benefit.

A test isn't always a binary 'you have X ' . Look at PSA screening for prostate cancer starting in your 40s is not recommended for that reason.

I'm aware but also not sure how that changes anything.

Say you're 40 and you get a positive PSA result, maybe that means your risk of having prostate cancer has gone from (for illustrative purposes) 0.1% to 2%. That means the next step is "what do you do to someone who has a 1 in 50 chance of having prostate cancer?", and the answer is almost certainly not a biopsy or anything majorly invasive. The answer might be a finger up the butt, an MRI, monitoring for symptoms, repeat the test in a year, etc.

The problem is that patients aren't used to handling these ambiguous results from tests because we don't do much routine testing, and doctors don't want to face the potential consequences for getting a positive test result and recommending against invasive treatment. However, in many cases, a test would still tell you something useful even if it won't directly be used to escalate to a more invasive test or treatment.

For example, if a routine blood test shows prediabetes (which has happened to a few people I know when having blood tests for unrelated matters), you won't get any treatment for it, but you may be referred to a dietician and have a fire lit up under your ass to make those lifestyle changes you've been putting off.

the test isn't the problem, it's that doctors and patients aren't used to making decisions based on probability (patients demand something must be done, while doctors run on vibes and cover your ass)

(context: spent some time working in a prostate cancer research lab and have doctors in the family)

>Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky

This isn't my experience. Every time I've gone in for an annual check, the doctor has either suggested that I get or asked if I would like a blood panel. Maybe you should try another doctor.

In my experience, a blood panel doesn't cover everything typically. My A1C, Insulin, and fasting Glucose levels are all within normal range, but actually I have insulin resistance, likely genetic that wouldn't appear in my general panel for at least two or three more decades. This is common in people whose family history includes poverty or subsistence farming. I'm glad I have the resources to address this while I'm still a young professional with no children of my own to manage and full healthcare benefits including out-of-network, but I had to find my own specialists to investigate what was going on with me.

Why would a genetic tendency towards insulin resistance be correlated with a family history of poverty or subsistence farming? Is there any research on that? Which specific genes are involved? Which tests were used to diagnose your insulin resistance?

I don't know the details. This was just something that I was informed after I was speaking to a specialist about a separate issue at a world-class medical campus, who happened to also be studying the effects of insulin on the thing I was actually there to get examined and after some testing and calculations that are more used in research than clinicals.

Given the context an epigenetic factor is also plausible.

I don't know why you would expect the healthcare system to do all of that stuff. If you want to know your VO2 Max you can just go to the local running track and execute a Cooper Test for free. But the results aren't really actionable. Regardless of the quantitative result, unless you're already an elite athlete the prescription will always be the same: exercise more.

Are you exercising enough or do you need to exercise more is an actionable question worth asking.

Enough for what? It's kind of a meaningless question. Unless you're already an elite athlete training 30+ hours per week, you could always benefit from doing more.

Absolutely untrue. There is such a thing as overtraining, having to eat a lot of food to make up for the energy expenditure from exercise, time constraints vs health goals, etc etc etc.

> broader blood panels, body scans (eg. Prenuvo), VO2 max, metals tests, mold tests, genetic tests, GI tests, etc etc.

Do you really need VO2 max test to tell you that you get out breath climbing a set of stairs? What genetic tests are you even talking about( brca ? ).

Is there any actual proof that "catching cancer early" has any long term impact on survival ? ppl can go waste their money if they really want for entertainment but I don't suggest burdening public healthcare with voodoo science.

> Wait until sick, get treated. Annual checkups are a weight check, blood pressure, a few questions, maybe a blood panel if you're lucky, and then a "you look great see you next year", aka, come back when you're sick.

What do we want them to do. They are not going to come to your my home and switch out your burger and fries with a salad.

I don't get where this notion that you need to go to doctor to keep yourself healthy even comes from. Its not a secret how to be healthy.

Are you asking if early detection of cancer results in better outcomes? Yes, the data unequivocally supports that diagnosing cancer before it spreads leads to lower mortality.

That’s only true if it’s actually a cancer that’s going to spread. Certain things like benign prostate cancer are often not worth treating. Testing everyone for everything leads to overtreatment and anxiety and worse quality of life.

I see the distinction. Thank you for clarifying. I think generally speaking I would prefer to have more data on my health. I don't like the idea that this information might be held back because it would make me "paranoid". That is my decision.

I can see that in the general case, it can lead to increased spending and worse outcomes.

> I don't like the idea that this information might be held back because it would make me "paranoid". That is my decision.

Yea you can get prenuvo or a psa test by paying out of pocket. No one is holding anything back from anyone. I got a PSA test out of pocket for $60 at quest ( family history of PC) .

Yes I put those in quotes because that's how Prenuvo sells their product to the public. If fullbody scans truly improve survival then they wouldn't need kim kardashian to sell their product.