Executive Physical on Steroids

[CoolChange]

A couple of other threads which are currently active in this forum prompted me to start this one.

Does anyone here have actual experience with any of the comprehensive health assessment where MRI’s, DNA sequencing, microbiome and other analysis are performed in addition to normal blood work, vital signs, etc. in a standard annual physical? I think of these as executive physicals on steroids.

I’ve seen news stories about these costing as much as $25K in the USA. But, this seems like an area very well suited to medical tourism for those of us who might be interested but are not in the 8 or 9 digit club.

 

[6miths]

Dumb idea. A fool and his money!

 

[pb4uski]

A couple of other threads which are currently active in this forum prompted me to start this one.

Does anyone here have actual experience with any of the comprehensive health assessment where MRI’s, DNA sequencing, microbiome and other analysis are performed in addition to normal blood work, vital signs, etc. in a standard annual physical? I think of these as executive physicals on steroids.

I’ve seen news stories about these costing as much as $25K in the USA. But, this seems like an area very well suited to medical tourism for those of us who might be interested but are not in the 8 or 9 digit club.

Back when I was working we had something similar to this but not as expensive or as comprehensive. It was called Executive Health Exam. Going from memory they did a normal physical (blood work, physical exam, etc) plus a EKG, vascular screening, etc. It cost about $2,500 (in 2011) and took a day.

It was worthwhile. One of our practice leaders got on the treadmill and was told to stop after less than a minute and to proceed directly to the hospital... do not pass go, do not collect $200... he went to the hospital and had heart surgery later that day.... his heart was a ticking time bomb... I knew the guy so it isn't some cockamayme urban legend story.

 

[Pilot2013]

Back when I was working we had something similar to this but not as expensive or as comprehensive. It was called Executive Health Exam. Going from memory they did a normal physical (blood work, physical exam, etc) plus a EKG, vascular screening, etc. It cost about $2,500 (in 2011) and took a day.

It was worthwhile. One of our practice leaders got on the treadmill and was told to stop after less than a minute and to proceed directly to the hospital... do not pass go, do not collect $200... he went to the hospital and had heart surgery later that day.... his heart was a ticking time bomb... I knew the guy so it isn't some cockamayme urban legend story.

Similar... employee where I worked about 12 years ago went for $99 MRI type scan of heart for blockages. They told him to go straight to the hospital, came out with triple bypass. Boss and I went and paid our $99 the next day. Thankfully, no repeat occurence.

 

[athena53]

My fear is the opposite. My dear mother once said that if you let them scan everything they'll find stuff you never knew was there and get all excited over it. Yes, sometimes it's a genuine ticking time bomb but sometimes it's stuff that will never give you trouble. Much of the gene sequencing and other technology is so new they don't really know what some of the results mean over the long run. I don't want the executive physical to lead to a lot of "it could be nothing but you need to have this other test" results.

 

[braumeister]

My fear is the opposite. My dear mother once said that if you let them scan everything they'll find stuff you never knew was there and get all excited over it. Yes, sometimes it's a genuine ticking time bomb but sometimes it's stuff that will never give you trouble. Much of the gene sequencing and other technology is so new they don't really know what some of the results mean over the long run. I don't want the executive physical to lead to a lot of "it could be nothing but you need to have this other test" results.

I agree completely. Everything I've ever read about this says the risk of false positives far outweighs the typical benefit. I've also heard a few anecdotes from people who took these things that made me shudder.

 

[Pilot2013]

I agree completely. Everything I've ever read about this says the risk of false positives far outweighs the typical benefit. I've also heard a few anecdotes from people who took these things that made me shudder.

As with any "information gathering", the brain has to be employed during analysis. That doesn't necessarily mean you act, but doesn't mean you ignore either. I look at all kinds of different financial analysis, and use my brain to determine what to act on....

 

[CoolChange]

Better to Know

As with any "information gathering", the brain has to be employed during analysis. That doesn't necessarily mean you act, but doesn't mean you ignore either. I look at all kinds of different financial analysis, and use my brain to determine what to act on....

This is along the lines of what I am thinking.

On a completely personal level, I have a few moles that my dermatologist examines very closely at my annual full body screening. (I am fair skinned with a family history of skin cancer and had a lot of sunburns as a child.)

• For many years running, my dermatologists have recommended merely monitoring these locations. They are not yet cancerous but are at risk of becoming cancerous. Excision, while very low risk, does still carry some risk and non-trivial cost.

• I have followed my doctors' advice and do not spend much time thinking about this other than monitoring these locations very closely via a monthly self-exam.

I think I would be fine with the wait and monitor approach and limiting additional tests to those with very low risks:

• Yes to more blood tests.

• Most likely no to biopsies, etc.

This is very similar to how I handle my financial life: I am constantly trying to learn more, run more models, etc. But, I do not make adjustments to my investments because of a single piece of information, model result, etc. This constant learning and modeling does occasionally uncover parts of my portfolio where I am taking more risk than I had realized. While this does not lead to an immediate change, it does focus my monitoring and additional research.

 

[Danmar]

I get a very comprehensive physical done very year. Started doing such about 30 years ago, when employer paid for it. Now cost about $2,500. Includes real time blood work, stress EKG, ultra sound, Abdominal X-rays, hearing, eyes, nutrition consult, physical exam including mole scan, DNA testing extra, long discussion with doc that has been on my file for about 20 years. Includes any necessary referrals. I think it’s worthwhile, but will only know for sure if they find something.

 

[ncbill]

I plan on updating my life insurance soon & as part of that any medical test I take is available to a prospective insurer...forever.

They only want some basic blood tests as part of the application process.

No chance in **** I'm going to do something which would only increase my chance of a denial.

 

[stephenson]

I'm surprised at those that had negative comments to the OP's question.

All of us have likely attended funerals of friends, or have talked with friends - wherein the statement, "...if they had caught it earlier ...," is made.

Given a reasonable cost, why would anyone NOT want more information about their health?

Take the information, us your head, do your own research (for goodness sake, do not listen to a single point of view from one doctor!), get second opinions, etc ...

I'm still kinda in shock about the negativity of some of the comments!! Especially, anyone using the word "fool" or a statement like "dumb idea" in a fora like this one!

 

[6miths]

Sorry Stephenson but it is hard not to weigh in heavily on a topic like this. This is not anything that is recommended by the medical community. This is purely marketing and a way to sell more tests. If I buy an MRI machine you can be damn sure that I am going to try to find ways to maximize profit from it. The idea that most things that kill people can be 'caught early' by some tricorder that someone has invented and then fixed without significant downside risk is just not true. Screening randomly for disease is problematic for many reasons. See braumeister's comment and then do whatever you please.

 

[stephenson]

Politeness is important.

My comments regarding the value of knowing more stand as I wrote them. They are my opinion and are meant to convey a respect for knowledge, which, granted, is NOT marketing. One needs to know the difference.

 

[REWahoo]

I'm surprised at those that had negative comments to the OP's question.

All of us have likely attended funerals of friends, or have talked with friends - wherein the statement, "...if they had caught it earlier ...," is made.

Given a reasonable cost, why would anyone NOT want more information about their health?

Your shocked view is far from universal.

Unless you have a family history suggesting the possibility of disease or were/are a smoker, I think the added radiation risk and other factors mentioned above outweigh the potential positives.

 

[RAE]

My fear is the opposite. My dear mother once said that if you let them scan everything they'll find stuff you never knew was there and get all excited over it. Yes, sometimes it's a genuine ticking time bomb but sometimes it's stuff that will never give you trouble. Much of the gene sequencing and other technology is so new they don't really know what some of the results mean over the long run. I don't want the executive physical to lead to a lot of "it could be nothing but you need to have this other test" results.

+1. I WOULD, however, like to be able to have my annual blood work include ALL of the individual tests that are important to me. I'm not a doctor, but I do a lot of reading and believe I have a good idea of the blood tests that would be most beneficial to my individual situation. As it stands now, though, I have to argue with the doctor about including several of them, because either the doctor or the insurance co. won't "approve" getting the test without a diagnosis they can somehow connect to that test. The problem is, I want these tests for PREVENTIVE purposes, not because I already know I am sick! Some of these tests are pretty basic, and inexpensive (serum ferritin, for example), while others may be a bit more expensive, but still very important to me (the test for LDL particle size, for example). I'm not talking about 100 different tests, either..........there are maybe a dozen that are most important to me. But I always walk out of my docs office with an incomplete list of tests being ordered. I guess the only way around this is to use one of the national labs (Quest is one) where you have your blood drawn and then just order the tests you want. They don't accept insurance, though, so of course it's going to cost me more. If the insurance companies were really serious about preventive care, they would cover some of these important blood tests........it could save a ton of $$ down the line when someone gets really sick and they end up having to cover those costs.

 

[braumeister]

Your shocked view is far from universal.

Unless you have a family history suggesting the possibility of disease or were/are a smoker, I think the added radiation risk and other factors mentioned above outweigh the potential positives.

I think this is a pretty good summary of the value (or lack of it) of screening tests.
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072602/

Screening tests are often advertised with slogans like “prevention is better than cure.” But most of them cannot influence whether someone will get ill. Many people wrongly mistake screening for “prevention,” and some think that having regular screening tests can protect them from a disease. But that is not the case: screening tests usually cannot prevent diseases. Sometimes doctors also tend to be too optimistic when it comes to the benefits of screening.

Here's another:
https://hbr.org/2009/09/executive-physicals-whats-the-roi
Generally, the employer—not the insurance company—foots the bill. It is perhaps a small price to pay for the assumed benefit, but often the reality does not live up to the promise.
...

Radiation exposure is another concern. A single whole-body CT scan delivers radiation equivalent to 400 chest X-rays. According to the National Academy of Sciences, for every 1,000 people exposed to this amount of radiation, one extra case of cancer is created by the testing.

However, the scans are costly and their benefits unproven, so most insurers won’t pay for them in a preventive context. And there are risks. Many times the scans are “falsely positive”: They detect suspicious-looking spots that turn out to be benign, raising needless worry and frequently prompting invasive tests. They also can be “falsely negative”: They may find nothing wrong when in fact a disease is present, creating a sense of security that leads the patient to ignore early warning signs.

But with all that said, I can see some value for some people in these things.

 

[kcowan]

I get blood screening every year, urinalysis, PSA test/DRE, and any further tests that those indicate would be good.

I am reminded of Bill Clinton getting all the medical attention except they missed an Angiogram.

 

[stephenson]

I kinda like the idea of getting a sonogram of my kidneys and finding an undetected growth .... simple scenario where a blood test might not find it, but a quick look with a sonar finds something life threatening?

 

[sengsational]

There are a lot of theories out there that have promise, but have not been accepted into the mainstream health establishment. Not all of these theories will pan out, but even those opposed to "extra" testing would probably agree that some of these will make their way into the work a day doctor's repertoire.

Those that are willing to give unproven theories attention often have motivation in the form of a problem that conventional medicine has few or no answers. Or the conventional answer is more harmful than good.

I wonder how many of those that think extra testing is worth knowing the results are dealing with conditions where the modern medical establishment has crummy answers (autoimmune for instance).

 

[MRG]

Sorry Stephenson but it is hard not to weigh in heavily on a topic like this. This is not anything that is recommended by the medical community. This is purely marketing and a way to sell more tests. If I buy an MRI machine you can be damn sure that I am going to try to find ways to maximize profit from it. The idea that most things that kill people can be 'caught early' by some tricorder that someone has invented and then fixed without significant downside risk is just not true. Screening randomly for disease is problematic for many reasons. See braumeister's comment and then do whatever you please.

Thank you for speaking.

DW had looked at this and it didn't seem wise. I asked my ast PCP, who walked on water, and he was against it.

Much of my scepticism is what are you going to do about it? Assuming it's real.

I think my new vets doing this in our 11 year old dog. A liver enzyme is high suggesting possible Cushing's. From what I read the acid test is "does the dog drink excessively"? No.

So instead of one set of bloodwork costing hundreds to ask about water consumption. We're going to do vitamins for months and repeat the original bloodwork! It's costing the same to get to the question of "does the dog drink excessively"!

I've been told this vet's good, and I believe there's truth to that. I also think she's going to profit on ignorant people.

 

[Pilot2013]

While the equipment manufacturers, and those that purchase the equipment, may "market" the tests, it does not diminish that the tests can provide information to be analyzed.

I tend to think there are those that would rather people NOT find out information earlier, much like I worry that after BILLIONS of $'s and 30-40+ years of research, we seem to only find additional TREATMENTS for cancer, no CURES.

 

[stephenson]

Again, one has to spend time assessing whether the testing is warranted.

I would suggest that while I would not spend significant money on animal testing when alternatives are available, I would certainly spend relatively more, far more, on my own longevity, and might consider time to be of the essence.

Every circumstance is different and should be researched accordingly ... oh, and yesterday’s optional tests have become today’s required tests in some cases. Likely, some of today’s optional testing will become some of tomorrow’s mandatory testing.

 

[athena53]

Every circumstance is different and should be researched accordingly ... oh, and yesterday’s optional tests have become today’s required tests in some cases. Likely, some of today’s optional testing will become some of tomorrow’s mandatory testing.

I agree- but by the time a test becomes "recommended", the medical profession has usually been through the learning curve of weeding out tests with too many false positives and establishing reasonable ranges of results for various patient groups (age, sex, co-morbidities, etc.)

I'm a believer in most of the current recommended tests; I just don't want to be on the cutting edge with others.

 

[audreyh1]

I wonder how many of those that think extra testing is worth knowing the results are dealing with conditions where the modern medical establishment has crummy answers (autoimmune for instance).

No kidding that they don't know what to do about autoimmune problems yet. There are some emerging theories about causes, such as the gut being the source of the problems, but no one really knows how to cure those problems yet.

 

[braumeister]

No kidding that they don't know what to do about autoimmune problems yet.

Just look at all the members here with autoimmune problems. There's no way you're going to convince them to buy a new auto.