Too Many Tests And Not Enough Data: No Doctor Need Apply

It is a well documented fact that cholesterol is a very poor predictor of heart disease. A statistically proven dictum: “80% of those who have heart disease have cholesterol numbers exactly like those who do not have heart disease.” Think about that.

Be precise; such calculations do not show that cholesterol has zero predictive power just that it is very weak and after all points to many other things as well. Like cancer, or thyroid disease or familial patterns of odd cholesterol some of which are protective and some of which are markers for serious risk of heart disease.

Now you can repeat this test, the measurement of cholesterol, a thousand times and it will not change these underlying facts. If the questions is whether or not YOU, not some statistical, generalized person, has a risk or even the presence of heart disease, again whether or not YOU need to worry about a stroke or heart attack then this test is only a little more useful than reading tea leaves. Test and retest: too many tests and no real data about the question of whether or not an individual has heart disease or even a risk.

Autopsies are good at telling whether or not you have heart disease but are very uncomfortable for the living. So get some tests that yield data that answers the question. Like a coronary artery scan, or carotid IMT, or more advanced blood markers like insulin, LDL particle size, or tests of the maturity or activity of your HDL levels, or inflammation; I could go on.

Let’s think for a minute. Why doesn’t every doctor recommend these more predictive, more accurate tests that yield real data and not just the same old panel of tests that tells you whether on not your liver is working or your sodium level is normal or any number of other tests which for the real patient without obvious liver or kidney failure mean nothing? Why would he not order what matters and instead order, over and over again, what does not matter? Well there is habit, standard of practice, ignorance, indifference; there are lots of things but the main one was hidden in that list: ‘standard of practice.’ Its what is ‘done.’ Its what everyone else does; it keeps you out of court. The pack is survival. Well that is only part of the answer and not even the most important one.

Here is the answer, not even hidden: my profession, physician, is in the long, slow throws of suicide. Here’s how it works. Underlying medical science identifies a marker, importantly it must be one that can have a drug tailored to change it, and then the drug is manufactured and then mandated to be given across a population on the statistical chance that its marginal positive effects can be statistically modeled to show ‘lives saved or changed’ and then, here is the suicide part, then you won’t need a physician to diagnose, dispense or monitor the drug’s use. Problem is, and it is coming out in ‘dribs and drabs,’ the drug has all kinds of problems that do not show up on a population scale until thousands have cataracts, kidney and liver failure, sore muscles, poor sleep, lower testosterone, on and on. Now this model underlies why most physicians are discouraged from precisely defining heart or for that matter many other diseases any better; by so doing they would escape the statistical model that could ever reasonably eliminate the need for a doctor, a physician, a healer. The forces in insurance companies, HMO’s, Medicare, etc. have no need for physicians. Frankly docs are a pain in the derriere. In the past a necessary evil but an uncontrolled expense and they complicate actuarial calculations.

Precision requires understanding, not lots of tests but the right tests and they do exist. So I challenge you. Go get your last 10 years of lab tests and then consider how many of all those numbers your doc has found important enough to discuss with you, to ask you to make changes to effect. You are a rare patient with a great doc if there are more than 3 out of 20 numbers tested and still they are ordered repeatedly; they are cheap. Useless but cheap. Besides they make us docs feel better; about ourselves.

Find out what matters, undertand how it works, find someone who will help you fix it and then MAKE IT BETTER.

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