Preventive medicine is a rapidly growing field. Testing that detects diseases in early stages, treatments that prevent diseases before they occur, and behaviors that make diseases less likely all hold the promise to keep us healthy and let us live longer. Unfortunately the field is also increasingly marred by tests and services that are recommended to patients without any scientific evidence that they work, or worse, despite much evidence that they are useless.
That’s why I’ve long been a disciple of the U.S. Preventive Services Task Force (USPSTF). The USPSTF is an independent panel of experts in primary care and prevention that systematically reviews the scientific evidence and develops recommendations for all kinds of clinical preventive services. They are the most objective and least biased national recommendations panel, because (unlike many professional organizations) they have no incentive to encourage or discourage the use of any service. (That’s why I included them on my Web Resources page.) So whenever a patient asked “Should I have an annual chest X ray” or “What tests should I have to check for ovarian cancer?” I always relied on their recommendations.
So I was delighted when my patient, Mr. Timo Kissel (thanks!), pointed me to a new feature that makes the USPSTF recommendations much easier to use by both patients and doctors. They have a new tool called the Electronic Preventive Service Selector (ePSS) which can be used on the web or downloaded to a PDA. The user enters his/her age, gender, use of tobacco, whether she is pregnant, and whether she/he is sexually active, and the website displays the recommendations tailored specifically for that person. Try it yourself. Go to the “Search for Recommendations” screen and enter your information. Find out what you should do to stay healthy, and what unnecessary testing you should avoid. (Be sure to look at the definitions of what the A, B, C, D and I grades mean.)
Some of the recommendations may surprise you and are counter to the practice habits of many doctors. For example, screening for prostate cancer with a PSA blood test or a rectal exam is still controversial, and there is insufficient evidence to recommend for or against such testing. Also, doing any kind of tests (like stress tests or CT scans) to look for heart disease in patients with no risk factors or symptoms of heart disease is known to be ineffective.
If you have the time, search around through the recommendations. I’ll be happy to answer any of your questions that come up.
I’m donating platelets again tomorrow. My new readers may have missed the last time I wrote about blood donation. I may bug you occasionally about donating blood. It’s important.