Which "doctors" do you listen to? Poor the patients.

StephenW

Cleveland Clinic's "Top Tests for 2012" Clash With Many Guidelines                        By: Gary Schwitzer  |                         January 02, 2012

The Cleveland Clinic sent out the following “News Tips” recently: “Top 5 Medical Tests for 2012 As we head into 2012, healthy New Year’s resolutions will abound. People will pledge to work out more, eat healthy foods and finally go to see their doctor for a physical. Cleveland Clinic experts note that there are a few tests that everyone should have during their yearly physical. For men, the following tests are recommended by many physicians:” Included in the list were: “High-sensitivity C-reactive protein – High levels of this inflammatory biomarker are predictive for future heart problems.” -  But the U.S. Preventive Services Task Force (USPSTF), by comparison, states that “the evidence is insufficient to assess the balance of benefits and harms of using high-sensitivity C-reactive protein  to screen asymptomatic men and women with no history of coronary heart disease.” “Vitamin D level – Low levels are associated with osteopenia, osteoporosis, breast cancer, colon cancer and heart disease.” But the Endocrine Society, by comparison, published a guideline recommending that doctors “screen for vitamin D deficiency in people at risk for deficiency, including obese individuals, blacks, pregnant and lactating women, and patients with malabsorption syndromes. “We do not recommend population screening for vitamin D deficiency in individuals who are not at risk,” the Society’s task force chair said. “PSA level – To screen for prostate cancer.” Do we really need to go through this again? The U.S. Preventive Services Task Force doesn’t make that recommendation.  The American Cancer Society doesn’t.  This kind of blanket recommendation for men of all ages to be screened for prostate cancer does not reflect the growing call for fully-informed, shared decision-making to take place regarding PSA testing. Then the Cleveland Clinic news tips goes on to say: “Women do not have to have the PSA test, but they should have a routine breast exam and pap smear.” But, by comparison, the USPSTF states that “the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older” and the Memorial Sloan-Kettering Cancer Center states that clinical breast exam “adds little to mammography in reducing breast cancer deaths.” Even the opening overall premise of the “News Tips” – that everyone should have a yearly physical – is a simplistic one-size-fits-all premise that is not universally endorsed. We’re going to see a lot of these “what to do in the New Year” health tips columns.   We hope more of them are more evidence-based than this one was. And we hope that journalists don’t act on these news tips without doing their own homework on the state of the evidence. One physician wrote on my blog that instead of saying, "For men, the following tests are recommended by many physicians..." try "For men, the following tests are often and inappropriately recommended by many physicians."