Physical Exams 1, Genetic Tests 0

A few weeks ago I wrote a piece about how some physical exam centers may be doing a disservice to their patients by focusing more on lab tests than a simple history and physical. Here’s a new example from the literature highlighting what I mean:

A recently published report in JAMA discussed the promising use of screening for heart disease by getting blood samples from patients and checking for 101 DNA changes that in previous research suggests possible association with heart disease. Unfortunately, the test didn’t find and statistical benefit in picking up undiagnosed cases. That’s too bad, but genetic testing remains a noble goal and scientists should continue to research this.

What did work, and has always worked, as an accurate predictor of heart disease, was self-reported family history. Yep, this incredibly simple tool still is a wonderful way to alert your family doctor and tailor follow-up tests accordingly.

This is exactly why I was so upset after my recent physical exam at a local center; I spent two hours performing a dozen lab tests, and never once did I even fill in any paperwork asking about my medical history, including a family history. All that money on expensive exams with little evidence-based support, and they still missed the most basic clues.

That, my friends, is a huge waste of precious healthcare dollars.

You can find the abstract here: JAMA — Abstract: Association Between a Literature-Based Genetic Risk Score and Cardiovascular Events in Women, February 17, 2010, Paynter et al. 303 (7): 631.

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