The Government Doesn't Care About You (and Never Will)

I'm going to lose my voice from shouting this yet again: Big Government doesn't care about you.

No one – not Big Government, not Big Pharma, not Big Banks – will take care of you. You can only take care of yourself. You are the only one with your own best interests at heart.

That's why last week's news report didn't surprise me at all.

The news reported a further delay on the enactment of an important Medicare law – the Protecting Access to Medicare Act of 2014. It put limits on docs to make sure they get approval before ordering imaging tests for Medicare patients. The reason here was to cut back on unnecessary testing done on seniors. It's costly at best... and downright dangerous at worst.

But five years later, that act has gone nowhere. It was delayed to 2020, and even then, it will be in place on a trial basis for a few years while Medicare decides just when it will get around to enforcing it.

The government doesn't want to interfere with doctors who are making bank by overprescribing tests. Remember, every test a doctor orders is another paycheck in his pocket from the insurance company.

And doctors know they're overtreating patients. A 2011 survey found 28% of doctors say they treat patients too aggressively. Only 6% think their patients don't receive enough medical care.

And a 2010 University of Washington study published in the Journal of the American College of Radiology showed that out of 459 CT and MRI scans, 26% were unnecessary. So just in that sample, 118 tests wasted money and time, and exposed patients to radiation for no reason.

So what can you do about all these tests? How do you know what's really necessary?

Personally, I advise you to check one place – the U.S. Preventive Services Task Force (USPSTF). The USPSTF is a volunteer panel of 16 MDs and PhDs whose specialties range from behavioral health to pediatrics. These experts look at the research data and make recommendations on the usefulness of screenings, counseling services, and preventive medications.

It's an unbiased, evidence-based group with a simple grading system. Its grades range from "A" to "D." (A "D" means the USPSTF recommends against getting the exam, while an "A" or a "B" grade means the USPSTF recommends the exam).

If the task force feels there's not enough evidence to either recommend or advise against a service, it could opt to assign the service an "I" for "inconclusive."

Some of the medical tests I recommend everyone get – like colon cancer screening and blood pressure tests – receive "A" ratings from the panel.

There are a few tests I've warned you against as well, partly because of their poor grades. Here are two of them, both related to America's No. 1 killer – heart disease.

Screening for Carotid Artery Stenosis (CAS): CAS is a narrowing of the carotid arteries due to a buildup of plaque. Some research suggests the buildup of plaque increases the risk of stroke. However, other evidence shows only a small portion of severe strokes are related to CAS, with only 1% of people 65 and older having severe cases of CAS (where 60% to 99% of the arteries are blocked).

Screening for CAS using an ultrasound test is well-known for yielding false positives – meaning the test shows artery blockages when there are none.

A false-positive result often leads to more invasive – and dangerous – procedures. And since studies show screening for the disease does little to nothing to reduce risk (especially for people who have no symptoms of CAS). USPSTF rating: D.

Screening for Peripheral Artery Disease (PAD): PAD occurs when arteries (typically in the pelvis and legs) narrow. This reduces the blood flow to your legs, leading to pain in your hips and legs. The narrowing of the arteries could be a sign that fatty deposits are accumulating in your arteries, reducing blood flow to your heart and brain and leading to an increased stroke risk.

However, the USPSTF found that screening for PAD doesn't result in any medical benefit (like reducing stroke risk). So don't waste your time and money on it. USPSTF rating: I.

Next time your doctor prescribes an exam, ask her if it's necessary. Don't be shy to ask if it's recommended by the USPSTF either. (In fact, your doc should have a copy of the panel's recommendations somewhere – my researcher's doctor has one taped up in his exam room for all his patients to see.)

What We're Reading...

Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
August 13, 2019