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Good Questions

Skip These Tests?

Tuesday, November 30, 2004; Page HE02

Nortin Hadler says he would sue any doctor who tried to test his cholesterol. Likewise, his bone density, prostate levels, colon cells, etc. The Harvard-trained doc, now in his sixties and a rheumatologist and professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, says you, too, should avoid these routine tests, as well as most angioplasties, bypass surgeries and routine mammograms. That's because -- contrary to what the medical establishment tells you -- the tests and procedures don't extend most lives, he says; they just convince healthy people they're sick. We spoke with him recently about this iconoclastic thesis that's at the heart of his new book, "The Last Well Person: How to Stay Well Despite the Health-Care System" (McGill-Queen's University Press, $29.95).

But wait a minute. Hasn't it been proven that some routine screenings, like PSA tests for prostate cancer, save lives?

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There is no question in my mind that if you remove all the prostates you are going to make a major difference in death by prostate cancer. But you are not going to make a major difference in death or the timing of your death. You're going to die about the same time of something else and there's a good chance that you're going to spend your post-radical-prostatectomy time coping with impotence and incontinence. The same [general principle] pertains to breast cancer, colon cancer and most heart disease.

. . . Most [of the breast cancer] that you find are local problems and you can find them, however, when it becomes a lump. . . . There are tragedies. I'm not willing to let you say [I'm] a callous fellow who is willing to accept a few deaths. That's terrible. Right now it looks like this approach is not doing what we are told it should be doing.

So if these screenings and procedures don't prolong our lives, what does?

About 85 percent of your mortal hazard lives in two questions: Are you comfortable in your socioeconomic status? And do you like your job? If you say no to either or both of those, that represents some of the most powerful mortal hazards that we are able to document.

Who's to blame for healthy people's preoccupation with illness?

I think a tremendous percentage of the health care delivery system is influenced by the profit structure of Big Pharma . . . the insurance industry and the . . . major medical centers, particularly the academic health centers. It is dripping with conflicts of interest.

So how do you personally deal with all this?

I will die, hopefully on my 85th birthday, and I don't really care which of the diseases that I'm bearing on my 85th birthday does me in. I only care that I made it to my 85th birthday -- plus or minus something -- and on that birthday I can look back and smile.

-- Elizabeth Agnvall

© 2004 The Washington Post Company


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