Much has been written about the over-testing of America. From cradle to grave, we are tested for educational, health, financial or employment purposes. Teachers bemoan the fact that they are training kids to pass tests, not provide a well-rounded education. The college application process requires test scores – despite the fact that professors are the first to admit that testing is no indicator of academic success at tertiary level. However, I have come to believe – and many studies support this – that with regard to our health we are completely over-tested, and it is a contributory factor to out–of-control healthcare costs in the USA. But it’s an emotional flashpoint – as well as a legal wrangle. At a big company I worked for years ago, people talked about the CYA memo – today it would be the CYA email, sent to multiple recipients. The Cover-Your-Ass message is at the heart of so much medical testing, and it is closely linked to the propagation of fear. Let me tell you about a recent experience.
A few weeks ago I went along for my annual “GYN” exam. Men – do not stop reading – you have wives and daughters, and no doubt you’ve had a test or two on your crown jewels, so this sort of thing could apply to you, too.
After the exam, the physician’s assistant looked through my notes and said, “I notice that there has been a case of breast cancer on your mother’s side of the family.” I nodded. It’s been there in my notes for years, without comment. Then she said, “I think you need to have DNA testing.” So I asked, “Why?” And she answered, “So we can assess your risk.”
At this point I explained that my family offers an excellent statistical example – my mother was one ten kids, seven of them girls, and I have more cousins than I can count – with the majority of them female, and all around about my age, give or take a few years. We do not exactly have a breast cancer epidemic, and there is no ovarian cancer. “I’m more likely to have a heart attack or a stroke,” I said. “Or a thyroid problem.” But she insisted it was the best thing to do.
“So, let’s say that there’s a result that indicates I have a high likelihood of either breast or ovarian cancer – then what?” I asked.
“Well, we would counsel you on lifestyle choices,” she replied.
“Such as?” I asked.
“Diet. Exercise. Alcohol consumption – do you consume more than 7 drinks a week.”
I laughed. “I would be hard pushed to knock back more than 7 in a month.”
“Then your diet?” she asked.
“I gave up red meat thirty eight years ago, dairy fourteen years ago,” I said. “I eat mainly organic chicken or fish, but only three or four times a week – the rest of my diet is vegetarian. I have to eat gluten and wheat free and I am not a sugar junkie.”
“Oh,” she said. “How about exercise.”
“Walk the hills for an hour and a half each day, and I train in a demanding equestrian sport three hours each day, five days a week. I also enjoy a brisk sit every now and again.”
“Oh,” she said, again.
“I’ve pretty much hit the lifestyle choices already,” I added. “I’m not overweight and I don’t smoke. Almonds are my weakness.” I paused. “And if that leaves doing an Angelina Jolie – forget it – I’m not having anything lopped off out of fear.”
Still she pressed me – and I knew that fear button was the one she had her finger on. I felt myself caving.
“How much is this test?” I asked.
“About $4000," she replied
“I can tell you now, I am not paying $4000 to be scared."
"Oh, your insurance will pay all but $400 of it," she said.
"Oh, your insurance will pay all but $400 of it," she said.
I could feel myself getting uppity – but no more uppity than the physician’s assistant was getting with me. Clearly not many people questioned the advice!
I told her I would consider. She said they would take my saliva sample anyway.
I paused. “Oh heck, you might as well go ahead with it then,” I heard myself saying.
I arrived home and I realized I was annoyed. I was really ticked off – with myself. I called my pal who’d had the test and asked her opinion – she was shocked that I had been advised to have the testing, as usually you have to have several risk factors (be from an African American or Jewish background, be a smoker or overweight). Then she said, “Oh well, it’s not a bad idea to get it done.”
I called the medical office and talked it over one more time, but because I could feel the woman getting really exasperated with me, I just let it go, and have tried not to think about it. I have an appointment for my “post-test meeting” to go over the results in a couple of weeks.
But here’s what I think. I think I have been led astray by fear itself, by an organization making money out of testing, and in a very subtle way preying on trepidation about what might – or might not – happen in the future. Several years ago, I remember reading that, despite the emphasis on family predisposition to (for example) breast cancer, in only 3% of cases of the disease is there a family connection. I think it’s a CYA move, and I also think someone is making a lot of money out of me providing a saliva sample, which was then sent to a laboratory somewhere – at $4000 a spit, that’s a nice little earner.
It reminded me of two other events. Some years ago, at the company where I worked, it came time for the annual visit of the various insurance companies under contract with my employer. We had to renew with our healthcare provider, and we also had to meet with another insurance provider to hear about the various supplementary insurances we might want – long-term care, emergency room supplement, and another little offering called “Cancer Insurance.” I listened to the brief run-through of the supplementary insurances, and then declined all of them – I couldn’t afford them, for a start. The agent looked at me and said, “Not even the cancer care?” I shook my head. “No. I don’t want that kind of paperwork sitting on my desk or in my home.” He shook his head and with something of a flourish, rapped his knuckles on the wooden desk. “Knock on wood,” he said. I leaned towards him and said, “What you just did amounts to intimidation. You are trying to scare me into that insurance, and I am reporting you to my employer. You will never set foot in this building again.”
He smirked. His error.
In his manner, by adding fear and superstition into the mix, what that insurance representative was doing amounted to blackmail. He never returned – not on my watch anyway.
So, I have been wondering whether to ask that physician’s assistant to keep those DNA results to herself. I don’t really want to know, but curiosity will probably get the better of me. Ultimately, it won’t change anything, except it might add a bit of stress – and we know how bad that is for you. Heck, I might have my seven drinks in one night!
When I was in my mid-thirties, in the Jurassic period, I was sent for heart tests – a pesky little arrhythmia along with a heart murmur had decided to make my life more interesting. First of all the cardiac tech listened to me while I explained to her that I didn’t understand how this had happened – I was a very fit woman. Then she asked two very important questions: “How’s your stress life?” and “Have you ever said, ‘I’m heartbroken.’” She had me there. I have never forgotten those questions.
It was later, while I was running on the treadmill, that she told me she also worked in the emergency room, adding, “And if there’s one thing I know in this world - working here and in the ER – we all come date-stamped. When your time’s up, there’s nothing you can do about it.”
OK, so I can live with that – it’s called making every day count. And you don’t do that by living in fear – whether it is a fear of not getting into the college of your choice, of not getting that job or of having yet another medical test. Some tests are worth it. Some are essential and help us live life to the full for as long as possible. And we mustn't forget that there are some crucial tests that people have to fight for. However, so many are costly, requested too often, and are just there to make money for the providers. On the other side of the coin let's also bear in mind that those providers may be afraid of legal repercussions if we are not offered certain tests. And for us, the mortals under the microscope, sometimes the pressure comes from trying to understand what is really important and also what does not serve us – so where our health is concerned, because we’re worried and not doctors, we end up being swabbed, injected, x-rayed and MRI’d until the cows come home. And collectively, we end up paying even more for our insurances – a whole industry built on fear and maybe.
As I left the office, having offered up enough saliva to test my DNA – while wondering what sort of Pandora’s box I’d just opened – the nurse called after me.
“Oh, by the way, you’re overdue for a mammogram.”
I nodded, and muttered to myself something that sounded a bit like “Heck.”