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A review of 21 published studies that evaluated the benefits and harms of periodic health evaluations (PHEs) on patient health and health care costs found that the benefits justify PHE implementation in clinical practice (Review, p. 289). The study found that people who had PHEs had more gynecologic examinations and Pap tests, cholesterol screenings and fecal occult blood tests and had less worry than those who had usual care. The available evidence did not reveal harms associated with the PHE, e.g., ordering or receiving inappropriate tests. The definitions of what constitutes an adequate PHE varied among studies reviewed. The authors say that more research is needed to clarify the long-term benefits, harms, and costs of receiving a PHE.
A three-sample clinical immunochemical test that measures the hemoglobin content of a stool sample (I-FOBT) had 88 percent sensitivity and 90 percent specificity for detecting colorectal cancer and 62 percent sensitivity and 93 percent specificity for detecting abnormal growths (Article, p. 244). One thousand patients considered at above-average risk for colorectal cancer received an I-FOBT, followed by a colonoscopy. The I-FOBT does not require dietary restrictions as does the guaiac-based FOBT. An editorial writer says that I-FOBT is a “potentially important test” for colorectal cancer screening (Editorial, p. 309). “It is a better test than guaiac-based FOBT for detecting occult bleeding and should be preferred to guaiac-based FOBT wherever FOBT is a component of a recommended screening strategy.”
A large and widening gap between the incomes of primary care physicians and those of many specialties discourages medical school graduates from entering primary care and endangers the future of the U.S. health care system, three physicians write (Perspective, p. 301). The income gap has been caused and perpetuated by four factors connected with the Medicare payment system, which also influences private insurance payers.