Most doctors don't know the cost of the tests they order

Health Scan: Mayo Clinic to cooperate with Sheba Medical Center; home genetic tests are often invalid.

By JUDY SIEGEL-ITZKOVICH
Most Israeli family physicians and general practitioners haven’t a clue about the costs of specific medical tests, and some don’t want to know, according to a study by Clalit Health Services recently published in the Hebrew-language journal Cardiology Update and Reviews. The researchers, headed by Dr. Yoav Shoham, queried 100 such doctors using an anonymous questionnaire.
Of the 82 who responded, 78 percent said they had never received any information about medical tests when they studied medicine or their specialty, and fewer than a quarter gave a correct assessment of costs. While 78% said they would be interested in getting ongoing information about the costs of the tests they recommend, 30% said such information would “not influence at all” their decision on how to test and treat patients. It is well known that many doctors send patients for unnecessary tests to protect themselves from lawsuits and not because all the tests were needed.
The authors noted that it was not possible for doctors to disregard the influence of economics on health services.
While the physician is obligated to do the best for his patients, the authors (who work for the country’s largest health insurer) write that medical staffers must comprehend the economic implications of their medical decisions, and that if less money were wasted on unnecessary tests, more would be available for lifesaving procedures and treatments. They recommended that health economics be taught to medical residents in hospitals, and that doctors be informed of prices on an ongoing basis.
MAYO CLINIC TO COOPERATE WITH SHEBA
The cardiology center at Sheba Medical Center has signed a strategic agreement with the world-famous Mayo Clinic that will permit physician exchanges between the two institutions as well as mutual consultation.
Prof. Michael Glickson, head of the pacemaker and electrophysiology unit at Tel Hashomer, said he and Dr. Amir Lehrman of Mayo have been working for two years on the project, which will benefit heart patients in both countries. During a joint event to mark the accord, a 78-year-old woman underwent catheterization and endoscopic surgery to receive a new heart valve without an open operation. The Mayo Clinic cardiac surgeons observed the surgery on a videoscreen and applauded the Israelis’ skills.
SELF TESTING NOT ALWAYS GOOD
Women are used to testing themselves for pregnancy with home tests, and others are available to detect blood in stools and glucose in the blood or urine. Direct-to-consumer (DTC) genetic tests are increasingly being marketed to the American public via TV, print ads and the Internet, providing individuals with genomic information without necessarily involving a doctor or insurance company.
A recent issue of the New England Journal of Medicine had an article by University of North Carolina medical geneticist Prof. James Evans and colleagues who stated that medical professionals “must ensure that rapidly evolving and multiplying genomic technologies are responsibly harnessed, and that their promise is not oversold to the public.” They argued that “a primary role of health-care professionals in the future may be to interpret their patients’ DTC genetic test results and advise them about appropriate follow-up.”
While the authors acknowledge that individuals should continue to be permitted direct access to their genomic information, they note that “consumers must be protected from unrealistic claims and the misinterpretation of complex and dynamic genomic information.”
They pointed out that in many cases, there is “little or no evidence of the clinical validity of tests developed from genetic technologies.” Their clinical validity data “are limited because they can be difficult and expensive to obtain, and because there is no US Food and Drug Administration requirement for the premarketing submission of such data for most genetic tests.”
FINDING MS FASTER
A new lab technique for early diagnosis of multiple sclerosis has been developed at Sheba Medical Center. The earlier the autoimmune disorder, which destroys the myelin covering on nerves and causes lack of function as well as pain, is diagnosed and treated, the better the outcome. During the past 20 years, the main diagnostic method was noting the presence of certain liquids in the spinal column, but this is only 85% accurate, with the rest false positive and even-more-dangerous false negative results.
Using the new diagnostic test developed by Dr. Batya Kaplan and Prof. Ben-Ami Sela, the accuracy has been boosted to 93%. The researchers found that a certain ratio between the level of various antibodies in the spinal fluid predicts the existence of MS. The new test is likely to replace the old one, which has been used for a whole generation.
CUTTING HYPERTENSION IN BARBER CHAIR
Red-and-white-striped barber poles date back to the time when barbers performed minor surgery. Today, barbers do not operate – although they may occasionally shed blood when they shave a customer.
But a hypertension expert at the Cedars- Sinai Heart Institute in California suggests that neighborhood barbers are well suited to monitor their clients’ blood pressure and educate them – especially African- Americans – about hypertension.
The recommendation follows a study, recently published in Archives of Internal Medicine, by Dr. Ronald Victor. He asked barbers not only to test blood pressure but also to refer those with irregular levels to see a doctor. The enhanced screening program markedly improved blood pressure levels among the barbershop patrons. Although blood pressure levels also fell in a comparison group whose members received only educational brochures about high blood pressure, the improvement was greater in the barber-assisted group. Barbers at the nine shops in the intervention group were trained to measure blood pressure properly, and offered free checks with every cut; if a customer’s reading was high, the barber encouraged him to see his doctor, and, if he did not, the barber called the study’s nursing staff to arrange a physician visit. The customer, in turn, got a free haircut if he returned to the shop with a doctor-signed referral card.
Uncontrolled hypertension is one of the most prevalent causes of premature disability and death among US blacks; the men have the highest death rate from hypertension of any race, ethnic and gender group in the US – three times higher than white men.
“What we learned from this trial is that the benefits of intensive blood pressure screening are enhanced when barbers are empowered to become healthcare extenders to help combat this epidemic of the silent killer in their community,” said Victor.
EAT YOUR BROCCOLI
Your mother must have told you to eat your broccoli. Now researchers at the University of Illinois have found that just three to five servings a week of broccoli is enough to have a real anti-cancer effect.
Elizabeth Jeffery, Michael Miller and Ren- Hau Lai found that sulforaphane – the cancer-fighting agent in broccoli – can be released from its parent compound glucoraphanin by bacteria in the lower gut. They published their research in the November issue of Food & Function.
This discovery raises the possibility that we will be able to enhance the activity of these bacteria in the colon, increasing broccoli’s cancer-preventive power,” the researchers said in a statement reported by UPI. The researchers proved it by injecting glucoraphanin into the ligated lower gut of rats and showed that sulforaphane is in blood from the mesenteric vein, which flows from the gut to the liver. “The presence of sulforaphane in measurable amounts shows that it’s being converted in the lower intestine,” Jeffery said. “Less than one daily serving of broccoli is enough to have an anticancer effect,” she added. “With many of the other bioactive foods you hear about, vast amounts are required.”