I was taught that wellness and preventive care have only one purpose: to restore health. They should not worsen your health or have dangerous side effects, and it goes without saying that they should not cause the very condition they are supposed to prevent.
But insurance companies and medical groups use the terms quite a bit differently. They routinely list screenings and medical treatments as prevention and wellness services. For example, we have all seen programs for “breast cancer prevention” that raise money for women to get mammograms. However, if I was a woman and really wanted to prevent breast cancer, I certainly would not have my breasts irradiated. A report released by the Radiological Society of North America states that repeated mammograms appear to be a cause of breast cancer in women who are genetically sensitive to X-rays.
According to the stricter definition I was taught, because mammograms do nothing to prevent the disease, and can even cause breast cancer, they do not qualify as “preventive care.” This is not to say they have no value. Mammograms certainly may be useful as a screening tool, for early detection of the disease. But preventive care is not the same thing as early detection. True preventive care for breast cancer would include treatments that actually reduce the risk of developing the disease. (More on that next week.)
Disease prevention also is not the same thing as wellness. For example, medical providers have recommended that older Americans take a low-dose “baby” aspirin daily to prevent heart attack and strokes from clots. But aspirin has serious, occasionally fatal side effects; one study suggests that you are twice as likely to be harmed from daily aspirin than you are to benefit.
Also, the blood-thinning effect of aspirin, which slightly reduces the risk of a stroke from a blood clot, actually increases the risk of a bleeding type of stroke. One study showed a 44 percent increase in this type of stroke in aspirin users, as well as a 45 percent increase in serious stomach bleeding.
Yet daily aspirin is considered a form of “wellness.” This is not wellness in my book.
The centerpiece of prevention and wellness care is considered to be the healthy checkup or “physical.” But a study published by the Cochrane Collaboration, in which they reviewed 16 previous studies on the regular medical physical, called the effectiveness of these exams into question. They found no improvement in deaths or overall disease rates in those getting regular checkups, including no drops in heart disease or cancer. The researchers commented that they were not looking at what they called “surrogate outcomes,” meaning they did not rely on improvements in a patient’s lab results (such as lower cholesterol) because such outcomes can be “seriously misleading.” Instead they relied only on outcomes including mortality, later hospitalizations, lost time from work and additional doctor visits.
True wellness falls into two categories: lifestyle advice and treatment. Unfortunately our current health care system leaves a lot to be desired in both areas. Dietary advice that includes replacing healthy, whole foods with highly processed, low-fat products defies the common sense wellness nutrition I was taught. Our current system discourages true wellness treatments such as acupuncture, chiropractic and nutrition therapy in favor of prescription medications and an over reliance on drugs to treat every ailment.
Next week I’ll cover some of the true wellness options available.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at firstname.lastname@example.org.