Americans are over tested, over diagnosed and over medicatedMar 23, 2021 10:13AM ● By Melanie Wiseman
Local physician says it's time to take back your health.Like many seniors, I was raised in a culture of “just do what the doctor orders.”
However, I’ve been fortunate enough to attend several of Dr. Phil Mohler’s eye-opening classes through New Dimensions. Now, I’m switching gears and following his suggestions on taking a more active role in my health care, and aging gracefully instead of fighting it.
Mohler, 79, is currently the medical director of Mesa County Public Health. He’s respected for his direct and honest approach to medicine—even when it comes to admitting that doctors aren’t perfect.
“One-third of everything we do in medicine has no value,” said Mohler. “Routine blood work on healthy people, for example, is a waste of time.”
“One-third of everything we do in medicine has no value,” — Dr. Phil Mohler
His in-the-trenches, unbiased medical advice has been published in local health columns as well as in “The Prudent Prescriber,” a monthly online newsletter dispersed to Rocky Mountain Health Plans (RMHP) providers. Conceived in 1998, he still writes the newsletter with help from RMHP pharmacist Steve Nolan.
Before retiring from his practice, 90 percent of Mohler’s patients were over the age of 50. He understands the medical challenges that seniors face, and believes that medical care and treatment is not one-size-fits-all.
“The most satisfied patients are those who take an active role in their own health care,” he said.
There’s a pill for that
Ever notice how many medical commercials there are on TV? The vast number of advertised drugs is no accident.
“America’s appetite for medical care is voracious,” said Mohler. “We are under the influence of Big Pharma TV advertising, our intolerance of uncertainty and ‘It’s what we’ve always done.’”
According to the Commonwealth Fund 2017, a private foundation that promotes a higher-performing health care system, the U.S. ranks top among first-world countries in per capita medical costs. Americans pay twice as much for medical care, yet score last among 11 comparable countries in access, equity and health care outcomes.
Mohler explained that pharmaceutical companies create new markets for disease by convincing us that common ailments as a result of aging are medical diagnoses. Pre-diabetes, male baldness, osteoporosis and high cholesterol are examples of “illnesses” created by pharmaceutical companies to make more money by selling more drugs. And it’s worked, with patients paying a top-dollar price for less than premium outcomes.
He also advised patients to be wary of “new diseases,” particularly ones such as restless leg syndrome and pre-hypertension.
“A lot of drugs you see on television aren’t great breakthroughs. They come with a high price tag and often not much data about how effective they are,” he said.
The cost of prevention
Mohler encouraged patients to consider the benefits and drawbacks of screenings that are meant to discover illnesses before they cause symptoms. While routine tests such as mammograms and prostate-specific antigens (PSAs) have saved lives, he warns that too-often false positives are detrimental to a patient’s health.
“Overdiagnosis is the phenomena that when you do a screening test, you can get one of four results: a true positive, a true negative, a false positive and a false negative,” said Mohler.
To better explain the concept, he used mammography as an example:
• A true positive is when the radiologist sees a lump and you get it biopsied and it’s cancer.
• A true negative is when the mammogram looks fine and you really don’t have anything.
• A false positive is when the radiologist sees a lump but it’s not really cancer at all.
• A false negative is when a mammogram looks fine but there’s really cancer that the doctor can’t see.
“As mammography gets better and we’re able to see smaller and smaller things, we do find some real cancers—but some of which if you’d never found them, nothing bad would’ve ever happened to you,” said Mohler.
False positives are often followed by additional tests and treatment, generating unnecessary expense and anxiety for the patient. But most physicians don’t want to take the risk of downplaying something that could prove deadly.
“So we label you with the ‘Big C.’ You get treatments, surgery, chemotherapy, radiation therapy and then we’ve changed your life forever,” said Mohler.
Just as pharmaceutical companies greatly influence America’s health care system, preventive screening is largely driven by the radiology industry. Despite America’s guidelines that call for annual breast cancer screenings compared to Europe’s endorsement of every two to three years, health outcomes for women in both regions are very similar. In some ways, Europe’s guidelines are better because patients don’t receive unnecessary treatment.
“Statistics from the last few years tell us that you have to mammogram 1,000 40-year-old women every year for 10 years to save one or two women’s life,” said Mohler. “In the meantime, you find a whole bunch of overdiagnoses and put women through this rigmarole that didn’t do them any good.”
Different standards of care
The difficulty with many health screenings is that they’ve not yet advanced to where doctors can tell whether the cancer that’s been detected requires treatment or can just be ignored.
“We’ll eventually figure out which cancers are the bad actors and which aren’t. Maybe we don’t do away with mammography, but maybe we don’t do it so early or we don’t do it every year,” said Mohler.
In the meantime, patients shouldn’t be afraid to ask their doctor about less invasive and less expensive treatments with similar outcomes. For example, in Europe, stool cards are the standard when screening for colon cancer instead of a colonoscopy.
“In Scandinavia, the standard of care with prostate cancer is to watch and wait, and treat only the patients who become symptomatic,” he said. “In the U.S., we treat everyone, even if treatment has no benefit.”
The first step in taking charge of your health, Mohler advised, is to develop a trusted relationship with a primary care physician.
“Every person should have a primary care physician who knows them and knows what they value,” he said.
He warned patients to be careful about asking physicians for a particular medicine; often a doctor’s desire to please will overrule good clinical judgment.
“Physicians are great at starting new medicines and lousy about stopping them,” he said.
Mohler taught his patients to keep lists of their medications and to ask each time they came in, “What can I stop?”
“Women are great at this,” said Mohler. “Men need to man up!”
3 questions to ask your doctor at EVERY visit
- Do I absolutely need this new test, prescription, X-ray or consultation?
- What will happen if I don’t take this medicine or do this test?
- Which of my medications can I stop?