We're experiencing an extraordinary time in the markets right now...
Things were looking up last year as folks started going back to work, stocks rose as the year ended, and life in general started going back to normal.
But 2022 has already been a rough year. Stocks have been on a roller coaster... Inflation is running wild... And investors aren't optimistic about the future.
I've heard from lots of worried readers wondering what's going to happen next.
So the other day, I sat down with one of my analysts – Jeff Havenstein – and we discussed why you shouldn't let fear rule your portfolio, where we're seeing signs of optimism, and whether or not we're headed for another recession.
Keep your questions coming our way at [email protected]. We read every e-mail. Here are some of the things on your minds this week...
Q: I recently received a solicitation in the mail for a screening or actually several different screenings. Are these worth the time/money and is there any benefit?
- Carotid Artery
- Heart Rhythm
- Abdominal Aortic Aneurysm
- Peripheral Arterial Disease
- Osteoporosis Risk
You might have addressed this in the past but if you did, I missed it. Thanks. – T.P.
A: Before I answer your questions on the screenings, beware of any sort of mail solicitation telling you to get any type of health screening. Plenty of these are scams, often targeting seniors. You do the screening, and the so-called health company bills you. Then you never get any results.
If you're concerned about specific health issues or screenings, that's a conversation for you and your doctor... not a random company that knows nothing of your medical history and simply wants your money.
OK... on to the screenings. In each case, it depends on lots of factors. So we'll go through each screening...
Firstly, if anyone ever recommends a specific screening to you, do your research. When we're evaluating screenings, we spend time combing through dozens of studies. But for most folks, we advise you to check one place – the U.S. Preventive Services Task Force ("USPSTF"). The USPSTF experts use 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."
Now, let's look at the screenings you mention...
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 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 Atrial Fibrillation ("AFib"): AFib is an irregular heartbeat that can lead to blood clots in the heart and strokes. This irregular heartbeat also puts you at risk for kidney disease and dementia. Risk of AFib increases with age, with about 10% of folks 80 and older having the condition. Most folks experience few (if any) symptoms before it's too late.
The Cochrane systematic review (the gold standard of health-related reviews) indicates that better screening starting at age 65 improves the rate of detection. This is important if you have risk factors like diabetes, heart disease, or obesity. USPSTF rating: I.
Screening for an Abdominal Aortic Aneurysm ("AAA"): An abdominal aortic aneurysm is a bulge in the abdominal section of your aorta, the large artery that carries blood from the aortic valve to the rest of your body.
Risks are higher in men, folks who have smoked, and people with cardiovascular disease. Most folks won't know they have an aneurysm until it causes a problem like a rupture, which can be fatal.
The USPSTF rating on AAA screening is a mixed bag. It only recommends a one-time screening for men aged 65 to 75 who have smoked. The rating falls to a C for those men who have never smoked. And for women, the USPSTF gives AAA screening a D for those who've never smoked and an I for women who have smoked.
Screening for Osteoporosis: Osteoporosis is the weakening of our bones, which usually occurs as we age. This weakening leads to an increased risk of falling and bone fractures. Men and women both experience bone loss with age, but women with osteoporosis outnumber men four to one.
Osteoporosis screenings usually involve a test called the central dual-energy X-ray absorptiometry ("DXA") that measures bone-mineral density. The central DXA takes a picture of the inside of your bone to determine its density. The test itself does use a small amount of radiation, which longtime readers know I'm always wary of, but the USPSTF found that the greatest risk from screening was just the anxiety patients experienced from the screening itself.
As for treatments, they can range from a simple calcium supplement (useless) to the popular drug class bisphosphonates to various hormone therapies. The treatment risk varies... For example, estrogen therapy increases the risk of stroke, heart disease, and even breast cancer. But several studies have found that bisphosphonates are relatively low-risk. In fact, we found one study that showed nitrogen bisphosphonates lowered risk of premature death by 39% in women. USPSTF rating: B for women, I for men (under review).
Screening for Peripheral Artery Disease ("PAD"): PAD occurs when arteries narrow, typically in the pelvis and legs. Then, reduced blood flow leads 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 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.
Don't do screenings randomly... If you're at high risk of certain health conditions, a screening might be worthwhile. Take a look at the screening and its treatments to familiarize yourself with all the risks and benefits.
The next time your doctor tells you that you need a specific exam (or treatment), make sure to question him about the reasons and the usefulness of the test. And check the rating from the USPSTF. If a test is positive, confirm it before dangerous treatment begins. Don't ever be afraid to get a second opinion.
Q: Is there a way to access some of the back issues of the Health & Wealth Bulletins (particularly regarding meditation)? – C.K.
A: Of course! We keep a full archive of our issues (nearly two thousand of them) on our website – healthandwealthbulletin.com.
To help get you started, here are some of our favorite issues on meditation:
What We're Reading...
- Did you miss it? Were you caught paying a $5 billion tuition bill?
- Something different: Stress over money is taking a toll on our mental health (video).
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
May 20, 2022