I will let the insurance company decide. They are smarter than our health care professionals.
I think all US insurers will pay for either – so insurance companies don’t “decide” this one.
Just went in for a physical and they recommended the fecal test followed by colonoscopy if any indicators show up. I dd have a clear sigmoidoscopy a number of years ago, too, though.
A different example:
Diagnosis of condition C, which causes no immediate problems. However, condition C could lead to conditions D1, D2, etc. years or decades later that need treatment. Unfortunately, there are no high quality studies indicating the risk of C leading to D1, D2, etc.; estimates range from 12% to 70%.
Procedure X is available prophylactically to treat C and prevent the possibility of C leading to D1, D2, etc., or it may be used only after any one of D1, D2, etc. occur. However, procedure X has a small risk of serious complications (probably 0.1% to 0.6%), but additional risk of smaller complications (probably up to about 10%) in addition to the usual inconvenience to the patient expected for X. Complication risk may be slightly higher for older patients. X also has a significant monetary cost.
If you are diagnosed with condition C, would you choose to have procedure X done prophylactically, or wait until any of D1, D2, etc. occurs (if none of D1, D2, etc. occurs, you may never need to have X done)?
@ucbalumnus, if you’re not going to use the actual names of the conditions, at least pick memorable phony names. I get mixed up with C, X, D1, etc.
For the case of the latest condition C, which sounds like Hep C, we need to know how bad D1, D2, etc. are, how quickly they will be detected if they happen, how much damage they will do before they are treated, and how much the treatment costs.
If there is a family disposition towards the disease, I would go for the more invasive test if it has a better rate of detecting the disease. If not, I might go for option 1 first and then alternate, so long as there is nothing in the results that indicate the disease is developing.
Here, for instance, I have had a couple of colonoscopies that have been entirely normal. I would be comfortable with doing the fecal blood test the next time IF my insurance no longer covered the colonoscopy, which might occur because they are talking about changing to a 10 year screening for normal results. For my H, however, whose mom has had polyps and who has had them himself, only the full test will do. For my kids, because of the family history, I would recommend the invasive test, at least the first time around.
Ok, the hypothetical in #23 is based on:
C = impacted wisdom teeth
D1, D2, etc. = decay in wisdom teeth, decay in adjacent teeth, cysts, periodontal disease, etc. related to impacted wisdom teeth
X = surgical removal of impacted wisdom teeth
Many of the D1, D2, etc. are harms that cannot be fixed by treatment, or the treatment is nasty. That is, if the wisdom tooth causes cavities in adjacent teeth, the cavities won’t go away with treatment. If the wisdom teeth cause all my other teeth to go out of alignment, I’d need braces to fix them, which are nasty.
Suppose I have Strange Hair Disease. If I don’t treat it, some years later my hair might turn green and spiky, and at that time I can treat the green spiky hair. Should I treat it now? My decision surely depends in part on how good the treatment is once I have green hair. If I can take a yucky pill and then my hair is no longer green and spiky, I’ll wait. If on the other hand, the treatment is “dye the hair and relax it,” then I’d just as soon prevent green spiky hair.
Same for wisdom teeth. Should I remove them, or wait for harmful results and then go for the removal? Well, those harms, if they happen, cannot be fully mitigated. Better IMO to yank out the offenders.
No brainer. I would have impacted wisdom teeth removed immediately. From what I understand, an impacted wisdom tooth may become painful and inflamed, so the hypothetical may not really apply. In addition, my kids have dental coverage up to age 26, which covers wisdom tooth removal. Three of the 5 have had it done already.
There are other situations -
For example, I have rheumatoid arthritis. My doctor wanted to put me on one of the injected biologic meds, but my symptoms are not chronic and I have flare ups every few years, which generally respond to methotrexate and/or prednisone, both of which have their own issues. I refused because the risks from the biologics outweighed the benefits for me, but I know people whose RA is worse than mine and they do take those meds. Every time I have a flare, I revisit the issue. Last time, I told the doctor I would try one if the flare didn’t subside after 3 months on steroids. Fortunately, it did.
In general, your choice depends on how wealthy you are. Your doctor’s advice depends on her or his car payment schedule. Your insurer would prefer a quicker but cheap death for you, rather than prolonged but costly suffering.
However, the potential harms of leaving the impacted wisdom teeth in do not occur to everyone, and many of the harms do not result in permanent damage to anything else once the wisdom teeth are removed.
Unfortunately, the lack of good studies means that it is difficult to assess the costs and benefits of prophylactic removal. However, the default option differs in different countries (e.g. US defaults to prophylactic removal, while UK defaults to removal only if a problem occurs).
As noted above, 3 of my 5 kids have had their wisdom teeth (or at least 2 of them) removed and not for prophylactic reasons. In all cases, they were impacted and causing pain. Son 2 is 23 and his have not yet even descended, ditto for S17. I wouldn’t have them removed just for the sake of doing it. Most of my friends have the same thought - they come out if they cause a problem, not just because they erupted.
The problem with the wisdom teeth example is that impacted teeth do tend to cause pain over time, but pain is subjective and the point at which the pain leads to the person seeking removal could vary. And at least in my experience, the availability of insurance or parents to pay for the procedure played a role as well. I had mine removed at age 21, my daughter had hers removed at age 22 in the spring of the year she was graduating college; her college medical plan included a per-tooth benefit for the removal, although not nearly enough to cover the procedure – but the oral surgeon’s office was happy to work with her on the billing end of these things.
In other words, I think our experiences were fairly typical: we knew our teeth were impacted. Our dentists told us that the teeth would probably need to be removed sooner or later, but that there was no urgency. (No evidence from x-rays that the teeth were actively causing problems). As we got older, we got to a point where the impacted teeth were bothering us. Not serious, life-changing pain – and certainly not constant pain - just enough that the pain became a fairly consistent source of discomfort. So that prompted us to decide to go ahead with the surgery - but that decision was based on the assumption that (a) if we didn’t do something, the pain would likely get worse over time, and (b) the procedure was expensive, and therefore it was better to do it while insurance and/or parents would pay for it, rather than putting it off.
Here’s what we don’t know: if we had opted not to get the surgery, would the pain have worsened over time? Or could we have continued for years with intermittent but chronic low grade pain? I’m sure that these days my knees bother me just as much as my teeth once did, but the joint pain is something that I just brush off as a normal result of aging, and I haven’t even mentioned it to my doctor – the pain would need to be a lot worse before I would think it needed treatment.
@calmom
You’re correct and I never said otherwise.
If I’m at low-risk for something, I’m getting the less-reliable but less invasive test.
I’m going through the colonoscopy only because I am at especially high risk for something. That, and the less invasive preliminary tests (blood, fecal, etc) have suggested there is a problem.
Since I have zero risk factors for colorectal cancer, I’d go with the FIIT test or whatever it’s called. That’s likely the correct route for most individuals.
Look, for the purposes of this thread and for most other things: statistics mean NOTHING to the individual.
Take the wisdom teeth example. Your statistics are fine and dandy for someone with the normal 4 wisdom teeth. Me? I had 5. Those statistics are now meaningless to me. I got mine out because I had to at least get the 2 out that were in the same place and I figured I might as well get the rest out while we were in there. (I also have a history of teeth/gum issues so it was decided that it was for the best.)
Another example: like @techmom99 I have RA (and lupus which throws statistics in a loop as it is) but I have severe RA. I was put on a biologic right away because my symptoms were so severe and the prednisone (that they put me on before I was correctly dx’ed) wasn’t doing the job.