One of my chief objections to the USPTF is its method of evaluating clinical research.
President Obama’s Independent Payment Advisory Board (IPAB) is going to reimburse physicians on the recommendation made by the USPTF without consulting subspecialty experts and dismissing clinical experience or judgment.
The USPTF should present its finding to the clinical specialists’ organizations in open forum for debate. There is plenty wrong with many of evidence based medicines’ conclusions.
Otherwise, the USPTF’s conclusions will simply undermine the patient physician relationship.
I believe I am qualified to critique the USPTF’s conclusions about osteoporosis in males.
The USPFT conclusions are dead wrong about evaluating and treating 70 year old men who might have osteoporosis. It is true that there are no large, long term, clinical studies evaluating the value of Bone Mineral Density studies and treatment of males over 70 years old for osteoporosis.
The USPTF concluded there is no clinical evidence to prove that osteoporosis evaluating and treatment in men is necessary. True, but it does not follow that if bone density studies are done and treatment started the treatment would not reduce the incidence of hip fracture by 50% as it does in women.
The incidence of osteoporosis in 70 year old men is high. All anyone has to do is go to a Wal-Mart anywhere in the nation on a Monday morning and stand at the front door. Clinical observation of retired 70 year old men will provide evidence for osteoporosis’ prevalence.
These men should be evaluated by bone density and then treated to prevent further fractures.
It would be cheaper for Obamacare to do this evaluation than restrict evaluation because of the lack of large studies to evaluate and treat.
The subsequent hip fractures will cost more in terms of morbidity, mortality and dollars than restricting access to early evaluation and treatment.
The government should collect the data to see how many men over 70 years old develop hip fractures. Then, calculate the cost of those hip fractures to Medicare against the cost of evaluation and potential treatment.
Males with osteoporosis do not present with back pain at the onset of a vertebral compression fracture. These fractures are mostly silent compared to women’s vertebral fractures. They will have a decrease in height and a low bone density.
It is not enough for the Obama administration to say it is interested in prevention of disease when it restricts access to prevention measures.
It is not right to restrict access to steps needed to prevent the debilitating or deadly complications of hip fracture.
The healthcare insurance industry and the government take 40% off the top of every healthcare dollar spent.
What percentage of the $2.5 trillion dollar healthcare bill is spent on the complications of chronic disease such as osteoporosis and other chronic diseases. The answer is 80% of the direct patient care dollars spent. The direct care dollars are $1.5 trillion dollars (150,000,000 million dollars) makes $325 million dollars a trivial amount at 2.16%. of the total spent on healthcare.
If Dr. Mehrotra was misquoted and the number is $325 billion dollars then the total spent on direct care for physicals and lab testing is 21.6%. or 11% of the total $2.5 trillion of healthcare dollars spent.
To me the trend to reduce physical examinations and lab screening is a ridiculous trend. The present spending probably should be modified some but not discontinued.
It has been shown it takes 8 years from the onset of asymptomatic Type 2 Diabetes Mellitus for a complication, myocardial infarction to occur. Diabetes Mellitus is first discovered in the cardiac ICU 8 years after the onset of Diabetes.
It has also been shown that males avoid going to physicians unless they are sick.
If Diabetes Mellitus was discovered early and treated effectively, there is a 50% chance the myocardial infarction could have been avoided.
Many diseases can be discovered on physical examination and routine lab testing. I takes time in the course of the natural history of a disease for the disease to become symptomatic or develop complications.
If discovered early and treated the complications of that disease can be avoided. Many patients’ lives can be saved with proper treatment.
USPTF drawing conclusions without input from specialists is dangerous and irresponsible.
Ignoring the diagnosis can be more costly in the long run for the government than avoiding testing for the diagnosis.