Friday, July 30, 2010

Health care by numbers, putting healthy people at risk

I was speaking to a patient today who was having some muscular problems and was concerned about.  He had just had his creatine levels checked (http://ezinearticles.com/?Creatine-Levels&id=405381) and the level was high.  Creatine levels that are high with cholesterol lowering drugs injestion is one of the reasons we need to be checked frequently when on these meds. I also suggested that some of his muscle stiffness and problems could be due to the drug.  When I asked him why he was having the problem, he said that his heart had a problematic valve which has likely been there all his life. When I asked him about his cholesterol levels, it was well under 200 which really is not high.

The important question is this:  Does the benefit outweigh the risk?  The patient has a known problem that is probably developmental.  Decreasing cholesterol levels that are near normal has no effect on heart function.  Taking cholesterol meds 5 times per week puts him at risk for liver and muscular problems, as well as adding medical costs to monitor him.  Since we are looking at a what if scenario which scares people because nobody wants a heart attack or a blockage to create a life threatening, what if we did nothing?  What if he got hit by a car tomorrow?

I know that is ridiculous but giving a perfectly healthy person dangerous (http://www.thepeopleschemist.com/view_learning.php?learning_id=11)  meds that potentially create problems he never would have had with constant monitoring makes little sense to me.  It is not preventative care, and has a detrimental effect, rather than a benefit over the short term. True preventative care prevents known outcomes such as foot problems creating back problems for instance, since it is mechanical and easily identifiable.  Shadow boxing with what if scenarios by physicians for dubious prevention of rare events is bad medicine.  Taking potentially harmful cholesterol lowering drugs that are likely to have no benefit but cause problems you do not have is not preventative, its foolish and a bad way to spend our health care dollars. Statistics show that statin's have a very small effect on extending ones life (http://www.dailymail.co.uk/health/article-432395/Statins-truth.html), and their benefits are way overstated. The best doctors question everything, including some of the practices of their own profession.  I have certainly done this as a chiropractor.  If you are a person who is on statins and has naturally low levels of cholesterol, but were advised these meds are a good idea, think about this article, the resources in it and have a fair and honest discussion with your doctor.  It is never about your doctors practice style, it is about your health and knowing the difference between prevention and an intervention that is good for your health vs. one that is not good for it.

What do you think, I value your opinion.