Domenick J. Masiello, D.O.
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Recommendations on Disease Prevention

With the exception of immunizations, conventional medicine does not have any reliable methods for disease prevention.

What we have instead is early detection. Early detection is exactly what it sounds like – finding the disease earlier rather than later. This is not prevention. Prevention means stopping the disease from appearing at all. Yes, there are some measures like wearing seatbelts to prevent fatal car accidents and the extreme measures of removing body parts so that cancer does not occur in that part. What I am talking about is advising patients about a life-style change which will truly prevent a disease. We don’t have that. Yes, we do have dietary recommendations for cancer or heart disease “prevention” but these are generally based on weak, epidemiological studies and assume that a multi-factorial disease can be prevented by a change in only one factor. It is just illogical and bad science based on correlation and not causation (the alternative medical world is also guilty of this).

Early detection, not prevention

So what am I saying? Should we ignore all these recommendations? No. Just understand them for what they are – early detection guidelines and not prevention guidelines. True prevention is about 20 – 30 years away. In the future, by analysis of our genetic material, medical science will be able to determine each person’s disease potential. Then each of us as individuals will know what we specifically need to do to maintain our health. Future genetic engineering will then offer us the possibility of changing our genetic structure so that chronic diseases never appear.

For the present, regular osteopathic treatments can minimize the extent to which some chronic diseases manifest themselves in the body. Historically, the founder of homeopathy, in his writings about chronic diseases, recognized disease patterns which we now realize as a primitive type of medical genetics. Later homeopaths, treating families for 2 and 3 generations noticed that patterns of chronic diseases could be changed by homeopathic treatment. Perhaps some day science will show that homeopathic treatment can positively alter our genetic structure. Until that time, despite its shortcomings, we can benefit from early detection guidelines.

The “average” individual

Before listing some of the guidelines it is important to understand that they apply to the “average” individual. This is a statistical entity. It doesn’t exist in reality. There is no average person, there are just individuals. So, if colon cancer screening is advised to begin at age 50, it is quite possible that you already have a small cancerous tumor at age 45. The recommendation is based on taking the average age when people have been diagnosed with colon cancer. An average signifies that there are always individuals who will be diagnosed before the recommended screening age and also those diagnosed after the recommended age if at all.

These recommendations also take into account the cost of such screening to the country as a whole. Therefore, in a country with socialized medicine like Canada, the Canadian Task Force on Preventive Healthcare tends to recommend fewer screenings than does the US Preventive Services Task Force. I personally believe that faced with the potential of a life threatening disease, the individual should not care about the cost to society. Who among us would give up the chance of catching a fatal disease early because it costs society too much money? That is why I am not opposed to the various walk-in screening centers. If one can afford it, there is absolutely nothing wrong with non-invasive coronary artery, lung and brain scanning. Yes, it may lead to more testing if “non-specific” findings appear but I think it is well worth the peace of mind. If something is discovered very early, one can try homeopathy or another alternative approach before conventional medicine must be used. This is a great thing.

Differences in recommendations

One final word about these recommendations. Different professional groups will have different recommendations. For instance, The American Academy of Family Physicians, the US Preventive Services Task Force and The Canadian Task Force on Preventive Periodic Health Examination do not recommend routine screening urine analysis. However, the American Academy of Pediatrics recommends that children have their urine tested once at age 5. The American Medical Association recommends that sexually active adolescent males be screened yearly for gonorrhea and Chlamydia (these are sexually transmitted diseases) by having their urine tested. Very often private medical groups for a specific disease (like diabetes, for instance) will have more stringent recommendations for screening. Who’s right? Well, here is one instance which shows that medicine is a science but is also mostly an art. In any given field it is possible for “experts” to disagree. Also, certain “high-risk” groups need to be tested more often for many diseases but if you haven’t been to a doctor in years or decades how do you know you are in a “high-risk” group?

US Preventative Services Task Force Recommendations

The screening recommendations listed below are derived from the US Preventive Services Task Force (USPSTF). They are currently working on the 2000 – 2002 recommendations so most of what is listed comes from Clinician’s Handbook of Preventive Services, 2nd Edition, 1998. The link to the Agency for Healthcare Research and Quality (AHRQ) will give summary recommendations on screening tests, immunizations and counseling for children, adolescents and adults from several different organizations (these may vary from the USPSTF so you may want to check the website) . I will list some of the major screening recommendations. There are about 80 recommendations!!! However, many of them are negative recommendations, meaning that no routine screening is currently recommended, so I won’t list those. Remember, these recommendations are for screening patients without symptoms, not patients who have gone to their physician because they are experiencing a disease related symptom.

Anemia – USPSTF recommends testing for high-risk infants and during pregnancy.

Blood Pressure – USPSTF recommends blood pressure measurement during routine office visits for adults and children.

Body Measurements – USPSTF recommends periodic measurement of height and weight.

Cholesterol Screening – is not recommended for children unless there is a strong family history of very high cholesterol levels. Men between the ages of 35-65 and women between the ages of 45-65 should be screened. There are many groups espousing different guidelines so check the AHRQ site mentioned above.

Cancer Detection by Physical Exam – breast exams on a routine basis are not recommended. Instead mammography with or without breast exam is recommended for women between the ages of 50-69. (there are many different recommendations – please check the AHRQ site and the Women’s Health section of this website). Cancer screening via pelvic exam for ovarian cancer and rectal exam for colorectal and prostate cancer are not recommended. However, opinions vary so check the AHRQ site above. Strangely enough, the USPSTF does not recommend screening for skin cancer so check the AHRQ site for other recommendations.

Fecal Occult Blood – The USPSTF recommends yearly testing for fecal blood in persons over the age of 50 as screening test for colorectal cancer.

Hearing – routine hearing tests for newborns are recommended for high-risk infants only. For adults, periodic questioning about a patient’s hearing during an office visit is sufficient as a screening tool.

Influenza – The flu kills thousands of people a year in this country, mostly among the very sick and debilitated. The flu vaccine is encouraged in the news media to prevent death among the sick but also as a productivity measure intended to decrease the number of sick-days taken annually in the US. It is usually portrayed as 100% effective, however, this is not the case. The vaccine is created many months before based on strains prevalent at the time. It is manufactured in late summer for distribution during autumn and winter months. In the interval between the selection of strains and patient inoculation, the outer protein coat of the virus in nature has changed somewhat making it more difficult for your immune system to recognize the virus thus rendering the vaccine only 75% effective at best. Flu doesn’t hit the Northeast US hard every year. Mostly what people suffer from are bad cases of the adeno or rhino viruses for which the flu vaccine is ineffective. Most importantly, homeopathy can effectively treat influenza and the common cold quickly and inexpensively. In the world-wide influenza pandemic of 1918, homeopathic mortality rates were around 1%, whereas, mortality rates from conventional treatment were around 30%. I have witnessed some reactions to the flu vaccine in my patients who wanted the shot. Some of the reactions were serious. The decision to have a flu shot should not be taken lightly and should be made on an individual basis with both benefits and risks taken into account.

Lead – The USPSTF recommends screening children at age 12 months for lead exposure.

Mammography – There is general consensus for screening mammography every 1-2 years for women age 50 to 70. Screening for younger woman and “high-risk” women vary. The best thing to do is go directly to this link and read all about mammography. (Scroll down to the section entitled: Recommendations of the USPSTF). Please note that the recommendations assume that your mammography facility is using the most up-to-date equipment and that the films are being read and re-read by radiologists certified in mammography. Unfortunately, very often this is not the case. Further, I have had patients who developed breast cancer after several years of normal mammograms. I now recommend that woman with normal mammograms undergo thermal imaging of the breast. It is non-invasive, does not involved radiation or squeezing of the breasts. It is a totally passive procedure which measures the heat generated by your body. While it cannot replace mammography it does provide another check of breast health. Click here for more info on thermal imaging. Also see the Women’s Health section of this website.

Newborn Screening – The USPSTF recommends newborns be screened between day 2 – 6 of life for the following: congenital hypothyroidism, sickle cell anemia, and phenylketonuria.

PAP Smear – The USPSTF recommends that woman be screened for cervical cancer with a PAP smear every three years starting from the first year that they become sexually active. Please check this link as there are several competing recommendations for this health issue. (Scroll down to the Neoplastic Diseases section and click on the link for Cervical Cancer)

Prostate Specific Antigen (PSA) – The USPSTF does not recommend routine screening for prostate cancer with serum PSA, digital rectal examination or ultrasonography. I strongly disagree and recommend you go directly to this link and read the various opinions. (Scroll down to the Neoplastic Diseases section and click on the link for Prostate Cancer)

Sexually Transmitted Disease and HIV – Go directly to this link to read the multi-page recommendation for screening for STDs and HIV. (Scroll down to the Infectious Diseases section and click on the link for HIV Infection)

Sigmoidoscopy – the USPSTF recommends either fecal blood testing or sigmoidoscopy as a method of detecting colorectal cancers. There is insufficient evidence to support one method over the other.

Thyroid Function – The USPSTF does not recommend screening asymptomatic patients for thyroid dysfunction. I strongly disagree. First of all, as fatigue is a symptom of an under-active thyroid, who in this world is asymptomatic? More importantly, I have seen a large number of mostly women patients with undiagnosed auto-immune thyroiditis. Many of these patients are needlessly in psychotherapy and/or on medication for depression due in large part to an under-active thyroid. Hypothyroidism and menopause is a very tough combination and many woman suffer through menopause because their thyroid is weak. Estrogen supplementation alone is not the answer as it actually lowers thyroid function. I recommend the TSH (thyroid stimulating hormone) test as a sensitive screening test for thyroid function. Further, if serial TSH measurements over several years indicate a weakening thyroid, I recommend ordering a blood test for thyroid antibodies to rule out auto-immune thyroiditis even if the total thyroid hormone levels are normal. This recommendation is at variance with the conventional wisdom so see this link for a standard discussion of this problem. (Scroll down to the Metabolic, Nutritional and Environmental Disorders section and click on the link for Thyroid Disease).

Tuberculosis – The USPSTF recommends testing high-risk individuals for tuberculosis. If a person tests positive but there are no signs of active disease, that person should be considered for prophylactic treatment. The BCG vaccine for tuberculosis is not recommended.

Urine Analysis – The USPSTF recommends urine analysis be performed on all pregnant woman.

Vision – The USPSTF recommends that the elderly be screened for visual acuity. Routine testing for glaucoma by family physicians is not recommended and the ideal interval for glaucoma testing by optometrists or ophthalmologists has not been determined.