All these tests these days

I'm in favour of tests, generally. Having said that, I only have one blood test each year, at my annual 'heart clinic' check up.

Some really interesting reading here 😃
I did read that most men die with an enlarged prostate and often cancer, but that’s with not of and there are many men with serious side effects where they’ve been treated, sometimes wrongly.
It’s a minefield isn’t it?

I don’t know about worried well - I think we have a very high number of worried very sick people waiting ! It isn’t free, we have to pay unless we are on a pension. Pensions are means tested and not that many get them. Completely different to the uk.

My cardiologist also takes a daily statin - his cholesterol is apparently in the "normal" range too.

A downside of more tests is an increase in unrelated incidental findings. For example, Australia has invested heavily in scanners whereas our NHS sits toward the bottom of the table. Australia now has cohorts of the worried well waiting for further investigations.

High BP and cholesterol are known silent killers. As medical knowledge improves then it is hardly surprising that advice on statins and BP drugs change. Many clinicians are in favour of a poly pill for all 50 year olds + comprising a low dose statin; a BP medication and aspirin. They believe that these drugs would act as a safety belt for the heart. A family member's cardiologist takes a daily statin even though his cholesterol is normal.

It’s got to be a good thing surely?
Preventative medicine is just as important, if not more so, as treating a condition once it has arisen.

If then a condition is picked up which doesn’t require treatment, we have the opportunity to try to ensure the situation doesn’t get worse.

I do think it's worth bearing in mind that "modern medicine" (ie drugs, etc) has only been around for less than 100 years I believe - which is peanuts in comparison with the human race having been around for at least tens of thousands of years.

Why chuck out everything we've learnt over all those centuries for something that is an absolute "baby" at only decades old- and that makes the drug companies lots of money? Even the most modern stuff we have is so very very primitive imo.

Admitted our recorded part of history only goes back about 10,000 years - and it's still currently difficult or impossible to find out what we did in the tens of thousands of years before that. But even recorded history is a pretty long period of time.

I know those "modern" tests found high blood pressure (but the 1970s basically thought blood pressure was fine at one's age plus 100 (in other words it's fine for vast majority of us) - but that doesnt keep the profits up for statins does it?

Another point from all this is that "modern medicine" and what I can see myself comes to about 10 ailments to get rid of!!!! That is a LOT. So commonsense also says "Deal with what I know I have myself - and then figure out if I've got any of the stuff they tell me I also have". Dealing with that many ailments at once would mean a lot of my time and money going on that - rather than actually getting on and "having a life". There's got to be a point to "having a life" imo (ie pursuing relationships and/or hobbies and interests = as otherwise why bother?).

So I'm dealing with what I know I have myself and that's putting me out with being there and then I'll think on after I've got rid of those things - ie as to whether there's owt else wrong to be got rid of.

Surely with all screenings we have to balance personal risk (of a false positive for example) against what we would tolerate by way of treatment.

I always ask lots of questions before any screening. Some things you know you wouldn't bother addressing - other things are easily remedied.

Yes on the last lot of tests my cholesterol was borderline. Clinician advised statins. I thought about it and decided to leave it until the next lot of tests. I am also at an age 80 where statins are not considered so beneficial.

But if the reading is higher I will give it further thought as well as talking through with the clinician.

I am off tomorrow at 11.30 to have a periodic mot blood test for various functions, like blood sugar, cholesterol, and other indicators. It really is a form of preventative medicine - hopefully anything can be caught at an early stage to save the nhs money and me grief, and the family hassle.

I also get my BP measured regularly.

It's about balance and the right information for me.
A year ago I was told my BP was high and I might need statins.
I questioned this as a result of a one-off reading and my cholestoral proved to be borderline.
I have not gone on statins.
My BP when read last week was 'perfect' as the nurse said.
Part of the problem is people lack confidence in using their own judgement and so get caught up in the process...but it's a tough one.

I think sometimes the changes in the range of people covered for tests is because there has been a change in the pattern of a disease and a group is now affected that wasn't in the past.

Both bowel, breast and cervical cancer have become more common in younger age groups, so testing is being expanded. the same with high blood pressure and diabetes.

The biggest problem is that the range of information a test for one problem can reveal. I was misdiagnosed with minor stroke a few years ago and had a brain MRI. Apart from revealing no evidence of a stroke it revealed, first, that I had a hole in my heart, not uncommon 25% of the population have one. Further testing revealed it was so small that if it been only a millimetre smaller they would not have been able to find it.

they also discovered that I had a small, slow growing benign tumour in my brain, a meningioma. Again these are not uncommon, rarely cause any problems, all that is needed is an annual scan, that shows that nothing is changing.

I have decided not to mention this to my children because it is unlikely to ever cause me any problems or contribute to the causes of my death, whenever that may be.. In the meanwhile why worry them about something that is highly improbable to ever cause me a problem.

Back in I think it was the 70s there was a journal article titled "Uncle Remus and the Cascade Effect in Clinical Medicine: Br'er Rabbit Kicks the Tar-Baby". In the classic story of Br'er Rabbit and the Tar-Baby, the other animals make a figure out of tar to play a joke. Br'er Rabbit approaches the figure and is annoyed when it does not answer his greeting. Eventually, he decides to teach the figure a lesson, and punches it. Of course, he gets stuck in the tar. The more he attempts to fight it, the deeper he is sucked in to the sticky tar. The author compares this to a care provider doing all sorts of tests for the simple reason that it is possible to do them. The more tests you do, the more likely you are to find something wrong - especially because with the way the tests are designed, a small number of healthy people are going to have an abnormal result. Of course, being a professional, if you find something abnormal, you're going to want to do something about it. The concern, though, is that, in a manner reminiscent of Br'er Rabbit, the provider ends up going further and further down a path involving increasingly more invasive procedures and additional testing - for a problem that may well have questionable clinical significance. The example the author gives in the article is that it's not uncommon for people to have a benign mass on their adrenal gland. In some cases, this mass may be a pheochromocytoma, which is a benign tumour that secretes adrenaline. This can be dangerous because it can cause an increase in heart rate and blood pressure that can put stress on the heart. In truth, though, while a benign adrenal mass is common, a pheochromocytoma is rare, so more than likely the mass is not significant - but of course, because you went looking for it and you found it, you now feel obligated to attempt to fix it.

Another example, one that wasn't mentioned in the article but is something I have heard of, is the age at which a smear test is recommended. It used to be the case that it was recommended for every woman at 18 years old, even if she had never had sex. Subsequently, it was discovered that in many cases of HPV with related cervical changes, if they're occuring in women under 21 years old, the body will typically clear the virus and any associated cell changes within 3 years. No need to do anything. But of course, if you found something, you'd want to address it - and depending on what you found, it could require more frequent monitoring, colposcopy, or even cervical biopsy. At best, this could cause unnecessary worry and unnecessary procedures with associated costs. At worst, if biopsies were taken, it can potentially affect a woman's ability to carry a pregnancy to term, because biopsies can thin the cervix and make it more likely to open too early. They subsequently increased the age at first screening (I think to 25 or something), and indicated that it should only be done at least three years after first intimate sexual contact, whichever is later.

Screening is all about balancing the risk of missing something important and the risk of finding something of questionable clinical significance, which you then feel obligated to address (with associated costs and risks to the patient).