5 ms·

A bit unrelated - but I always thought the American concept of "annual checkups" sounded a bit weird. Here where I come from, Norway, that is not a thing - unle

A bit unrelated - but I always thought the American concept of "annual checkups" sounded a bit weird. Here where I come from, Norway, that is not a thing - unless you have / or have had some serious illness in the past. Obviously cancer patients, or those in remission, get checked up every x months. But for regular people, it's pretty much not a thing. It also made me wonder: How much more would it cost our health-care system, if everyone took advantage of things like annual checkups, or going through those extensive screens/tests that a lot of American patients go through. I guess the fear of malpractice lawsuits, higher insurance rates, or whatever make the medical centers in US a bit more incentivized to catch anything at all. But AFAIK, we don't have any higher mortality rate here than those living in the US. Earlier this year I went to the doctor, because I was feeling a bit lethargic - turned out I had severe vitamin D deficiency. But other than that, it must be 7-8 years since I talked with a doctor. (But credit where credit is due - the US seems like an excellent option IF you really need to get treated for certain cancers. It's not like we have "death panels" or awful long wait time here, but I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.)

paulcole 4y ago
Part of the reason why it’s a thing in the US is that a huge number of people do have/have had a serious illness in the past: heart disease, diabetes, obesity, etc. Part of the reason they have those illnesses is because they neglected their health due to the cost of prevention.
- trgn 4y ago
  Is this really the case though? The annual check up is something that's been advocated a long time, 50s at least, and predates the obesity epidemic. The annual checkup is a symptom of a therapeutic view of health care, a view which cannot be divorced from modernism. The body is a machine which must be oiled and greased, frequently submitted to tests and expert investigation, so it can be tuned perfectly, just like a car, like a machine. This really was _the_ obsession in post war America: that all human activity (really, all of it), needed to be mediated by technology. This included personal transportation, education, cooking, ... and also maintaining our health. And that is where we are now; a chronically medicated population and a bureaucracy optimized to propagate this state of affairs. The annual checkup fits perfectly in this mindset.
- chmod600 4y ago
  What's the cost of preventing those diseases? Aren't those mostly diet/lifestyle?
  - paulcole 4y ago
    Diet and lifestyle aren’t free.
    - carlmr 4y ago
      A plant-based diet can be cheaper than a lacto-carnivorous diet. Sports on the other hand do take a lot of time.
      - hansvm 4y ago
        Implicit in that statement (taken together with the comment you're responding to) is the assumption that the kinds of plants cheaper than meats and dairy are healthier than a lacto-carnivorous diet. Locally, chicken and live anchovies are cheaper than lettuce, tomatoes, broccoli, and even beans and rice when denominated in pounds, sulfur, protein, calcium, B vitamins, .... I can understand the argument for having a high level of plants in your diet, but I'm skeptical that it's cheaper to live on just plants unless you only count calories and no other nutrients. Plus I think they were probably talking about how all of those options are vastly more expensive than living on Raman and peanut butter sandwiches, especially once you count for prep time and power costs.
      - paulcole 4y ago
        Cost isn’t just money.
dghlsakjg 4y ago
Just FYI, annual checkups are recommended, but certainly something that a lot of young people skip. A quick google shows that only around 60% of Americans see a doctor yearly. The checkup also isn’t a battery of tests unless you are at an age or condition for that. For a healthy 20 something that goes it’s basically the doctor checking your blood pressure and asking if anything has changed.
- kurthr 4y ago
  Yeah, that annual check-up is a 15min consult with maybe a blood test or a mail in colon cancer test even if you're 55+. Many people will completely ignore extreme signals of unhealthiness (pain, shortness of breath, trouble sleeping), because it's "normal" while another group simply can't believe they don't have some treatable disease to explain all their aliments. This research was about just cancer detection/treatment, but it's worrying that once they only mention correcting for smoking rates (umm duh, that's the least you need to do)... but then they don't mention weight... so weird?
decebalus1 4y ago
Not to defend anything about the American model (I personally hate it and think it's broken) but the annual checkup is a very cheap way of dealing with a possibly expensive condition. The checkup is non-intrusive and for presumably healthy people consists of a physical, basic blood tests (glucose and some metabolic indicators + infection markers) and a blood pressure check. As an example, it's way cheaper to find out you have pre-diabetes this way, than to go to the doctor with symptoms when you have full on diabetes. This is mainly the reason why insurances pay for these in full, as they're part of 'preventive care'. > How much more would it cost our health-care system, if everyone took advantage of Annual checkups are definitely not the reason healthcare costs are sky-high in the US.
- kwhitefoot 4y ago
  > the annual checkup is a very cheap way of dealing with a possibly expensive condition. Is it? Or is it something that just seems obvious?
  - alexanderdmitri 4y ago
    Both if the checkups help catch issues early or avoid them [0][1]. [0] https://www.cdc.gov/pcd/issues/2019/18_0625.htm https://www.cdc.gov/pcd/issues/2019/18_0625.htm [1] https://www.bbc.com/news/health-35073966 https://www.bbc.com/news/health-35073966
    - kwhitefoot 4y ago
      Neither of those links provide any numbers or good reasons to think that Cuba and the US can be easily compared. So while I agree that the idea is attractive and plausible, it remains merely an idea. And it is an old one too, I remember reading somewhere that in ancient China doctors were paid while you were well but you stopped paying if you fell ill so it was in the doctor's interest to prevent you falling ill. I have no idea if the story is true but it does suggest that the idea is not new.
lr4444lr 4y ago
Wait a sec: mammograms, postate exams, colonoscopies? You don't have these regular screenings when you hit a certain age? AFAIK, the data is very good on the early detection power of these exams.
- pessimizer 4y ago
  > mammograms, prostate exams For these two, the data is very good that we're doing them too early.
  - deskamess 4y ago
    What is the right time? Here in Ontario, Canada a letter gets sent at around 50 (I think) asking you to do a FIT test. Call your Dr, get the kit, do the self-test and mail it in.
pessimizer 4y ago
> I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway. The US is outstanding at taking money from sick people, just not any better at getting them well.
- deleted 4y ago
  [deleted]
bnjms 4y ago
> It's not like we have "death panels" or awful long wait time here, but I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.) This sounds like the right way to go, but I want you to understand this is exactly what people mean when they say “death panels”.
- tetraca 4y ago
  The argument never made sense to me because that's surely not much different from how a private insurance company in the US already operates - you can bet they have a team of actuaries who has calculated the exact point it's probably not worth their money to try to save a patient.
sneak 4y ago
It's also a Japanese concept. Regular low-cost health screenings can catch big problems early. You don't get annual bloodwork performed? Does your cat/dog?
- kwhitefoot 4y ago
  Also from Norway: no I don't, nor anyone else I know, certainly not any pets. Women get regular mammograms after a certain age; prostate examinations are offered if you are concerned and if anything is found then more frequent checks will be offered but nothing like annual checks for people not known to have a problem.
  - sneak 4y ago
    I wonder if us/jp are the outliers here, or if Norway is.
raverbashing 4y ago
Well, overdiagnosis/overtreatment is an issue Both approaches have pros and cons, because while an early diagnostic of some diseases can make a huge difference, there are also false-positives and needless invasive procedures (And I guess the people that are the most oblivious about their health are the ones that are more prone to have lifestyle related conditions - some people have never measured their blood pressure or blood glucose)
Gatsky 4y ago
If you are male, your life will probably be wrecked at some point by a heart attack/stroke or prostate/bowel cancer. The risk of cardiovascular disease can be reduced in various ways. You also might have rarer but more significant risk factors for premature death from cardiovascular disease (eg Lp(a)). There is still an unacceptably high rate of death or severe disability from the primary cardiovascular event ie. you don't get a second chance, as the first sign of the disease can be fatal or disable you permanently. The screening tests one has in an annual checkup are not 'extensive' really, it is asking questions about lifestyle and family history, checking lipids, routine bloods, blood pressure and doing cancer screening after certain ages. The chance of an incidental finding resulting in harm is very low with this kind of thing. Has a proactive, annual checkup model been properly compared to doing nothing on a population level? No. But on an individual level, it makes a lot of sense. I would say it is not useful to compare mortality rates between countries. Norway has the highest GDP per capita anywhere for example, and is quite culuturally, geographically and genetically homogeneous. How would you make a useful comparison to the USA?

paulcole 4y ago

Part of the reason why it’s a thing in the US is that a huge number of people do have/have had a serious illness in the past: heart disease, diabetes, obesity, etc. Part of the reason they have those illnesses is because they neglected their health due to the cost of prevention.

trgn 4y ago
Is this really the case though? The annual check up is something that's been advocated a long time, 50s at least, and predates the obesity epidemic. The annual checkup is a symptom of a therapeutic view of health care, a view which cannot be divorced from modernism. The body is a machine which must be oiled and greased, frequently submitted to tests and expert investigation, so it can be tuned perfectly, just like a car, like a machine. This really was _the_ obsession in post war America: that all human activity (really, all of it), needed to be mediated by technology. This included personal transportation, education, cooking, ... and also maintaining our health. And that is where we are now; a chronically medicated population and a bureaucracy optimized to propagate this state of affairs. The annual checkup fits perfectly in this mindset.
chmod600 4y ago
What's the cost of preventing those diseases? Aren't those mostly diet/lifestyle?
- paulcole 4y ago
  Diet and lifestyle aren’t free.
  - carlmr 4y ago
    A plant-based diet can be cheaper than a lacto-carnivorous diet. Sports on the other hand do take a lot of time.
    - hansvm 4y ago
      Implicit in that statement (taken together with the comment you're responding to) is the assumption that the kinds of plants cheaper than meats and dairy are healthier than a lacto-carnivorous diet. Locally, chicken and live anchovies are cheaper than lettuce, tomatoes, broccoli, and even beans and rice when denominated in pounds, sulfur, protein, calcium, B vitamins, .... I can understand the argument for having a high level of plants in your diet, but I'm skeptical that it's cheaper to live on just plants unless you only count calories and no other nutrients. Plus I think they were probably talking about how all of those options are vastly more expensive than living on Raman and peanut butter sandwiches, especially once you count for prep time and power costs.
    - paulcole 4y ago
      Cost isn’t just money.

dghlsakjg 4y ago

Just FYI, annual checkups are recommended, but certainly something that a lot of young people skip. A quick google shows that only around 60% of Americans see a doctor yearly. The checkup also isn’t a battery of tests unless you are at an age or condition for that. For a healthy 20 something that goes it’s basically the doctor checking your blood pressure and asking if anything has changed.

kurthr 4y ago
Yeah, that annual check-up is a 15min consult with maybe a blood test or a mail in colon cancer test even if you're 55+. Many people will completely ignore extreme signals of unhealthiness (pain, shortness of breath, trouble sleeping), because it's "normal" while another group simply can't believe they don't have some treatable disease to explain all their aliments. This research was about just cancer detection/treatment, but it's worrying that once they only mention correcting for smoking rates (umm duh, that's the least you need to do)... but then they don't mention weight... so weird?

decebalus1 4y ago

Not to defend anything about the American model (I personally hate it and think it's broken) but the annual checkup is a very cheap way of dealing with a possibly expensive condition. The checkup is non-intrusive and for presumably healthy people consists of a physical, basic blood tests (glucose and some metabolic indicators + infection markers) and a blood pressure check. As an example, it's way cheaper to find out you have pre-diabetes this way, than to go to the doctor with symptoms when you have full on diabetes. This is mainly the reason why insurances pay for these in full, as they're part of 'preventive care'. > How much more would it cost our health-care system, if everyone took advantage of Annual checkups are definitely not the reason healthcare costs are sky-high in the US.

kwhitefoot 4y ago
> the annual checkup is a very cheap way of dealing with a possibly expensive condition. Is it? Or is it something that just seems obvious?
- alexanderdmitri 4y ago
  Both if the checkups help catch issues early or avoid them [0][1]. [0] https://www.cdc.gov/pcd/issues/2019/18_0625.htm https://www.cdc.gov/pcd/issues/2019/18_0625.htm [1] https://www.bbc.com/news/health-35073966 https://www.bbc.com/news/health-35073966
  - kwhitefoot 4y ago
    Neither of those links provide any numbers or good reasons to think that Cuba and the US can be easily compared. So while I agree that the idea is attractive and plausible, it remains merely an idea. And it is an old one too, I remember reading somewhere that in ancient China doctors were paid while you were well but you stopped paying if you fell ill so it was in the doctor's interest to prevent you falling ill. I have no idea if the story is true but it does suggest that the idea is not new.

lr4444lr 4y ago

Wait a sec: mammograms, postate exams, colonoscopies? You don't have these regular screenings when you hit a certain age? AFAIK, the data is very good on the early detection power of these exams.

pessimizer 4y ago
> mammograms, prostate exams For these two, the data is very good that we're doing them too early.
- deskamess 4y ago
  What is the right time? Here in Ontario, Canada a letter gets sent at around 50 (I think) asking you to do a FIT test. Call your Dr, get the kit, do the self-test and mail it in.

pessimizer 4y ago

> I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway. The US is outstanding at taking money from sick people, just not any better at getting them well.

deleted 4y ago
[deleted]

bnjms 4y ago

> It's not like we have "death panels" or awful long wait time here, but I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.) This sounds like the right way to go, but I want you to understand this is exactly what people mean when they say “death panels”.

tetraca 4y ago
The argument never made sense to me because that's surely not much different from how a private insurance company in the US already operates - you can bet they have a team of actuaries who has calculated the exact point it's probably not worth their money to try to save a patient.

sneak 4y ago

It's also a Japanese concept. Regular low-cost health screenings can catch big problems early. You don't get annual bloodwork performed? Does your cat/dog?

kwhitefoot 4y ago
Also from Norway: no I don't, nor anyone else I know, certainly not any pets. Women get regular mammograms after a certain age; prostate examinations are offered if you are concerned and if anything is found then more frequent checks will be offered but nothing like annual checks for people not known to have a problem.
- sneak 4y ago
  I wonder if us/jp are the outliers here, or if Norway is.

raverbashing 4y ago

Well, overdiagnosis/overtreatment is an issue Both approaches have pros and cons, because while an early diagnostic of some diseases can make a huge difference, there are also false-positives and needless invasive procedures (And I guess the people that are the most oblivious about their health are the ones that are more prone to have lifestyle related conditions - some people have never measured their blood pressure or blood glucose)

Gatsky 4y ago

If you are male, your life will probably be wrecked at some point by a heart attack/stroke or prostate/bowel cancer. The risk of cardiovascular disease can be reduced in various ways. You also might have rarer but more significant risk factors for premature death from cardiovascular disease (eg Lp(a)). There is still an unacceptably high rate of death or severe disability from the primary cardiovascular event ie. you don't get a second chance, as the first sign of the disease can be fatal or disable you permanently. The screening tests one has in an annual checkup are not 'extensive' really, it is asking questions about lifestyle and family history, checking lipids, routine bloods, blood pressure and doing cancer screening after certain ages. The chance of an incidental finding resulting in harm is very low with this kind of thing. Has a proactive, annual checkup model been properly compared to doing nothing on a population level? No. But on an individual level, it makes a lot of sense. I would say it is not useful to compare mortality rates between countries. Norway has the highest GDP per capita anywhere for example, and is quite culuturally, geographically and genetically homogeneous. How would you make a useful comparison to the USA?