Have you implemented an executive health program to make sure that you do not lose key members of your leadership team to premature chronic illness, disability, or death? I am sorry to say that It is very likely that you are not getting what you think you are buying.
This is because there is a 17-year gap between new medical knowledge development and its broad implementation in the health care system. Executive physicals and health programs are no exception to that rule. Most executive health programs include interventions that are a combination of high cost and low efficacy.
Many recommended executive physical screening tests offer no value and may even cause harm.
The United States spends $300 million dollars on unnecessary tests associated with annual physical exams. Billions more are spent on useless follow-up tests and treatments.
What we know about executive health programs
The executive health program at one of the leading clinical institutions in the country is a case in point. They recommend an annual physical exam, an annual EKG, chest x-ray, a stress test, and blood work. Consensus recommendations from the leading experts tell us these tests have no value and may cause harm.
It makes no sense to burn money and valuable executive time for no benefit.
If these interventions provide no value to your executive team, what testing and treatment actually do make sense? The answer to this questions is as follows:
A strong primary care doctor relationship provides the best protection against chronic illness, premature death, and premature disability.
What are the recommended tests that an executive health program should include?
1. Annual Screening for Cardiovascular Conditions and Low Thyroid
- Strongly encourage your executives to see a primary care doctor at least annually
- Check the blood pressure annually to screen for hypertension
- Check a fasting glucose and a 2-hour glucose annually to check for diabetes and prediabetes
- Check a standard lipid panel and TSH annually to check for high LDL cholesterol and low thyroid which can adversely impact energy, cholesterol, and weight
Here are the American Cancer Society Recommendations for Screening
2. Breast Cancer
- Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so
- Women age 45 to 54 should get mammograms every year
- Women 55 and older should switch to mammograms every 2 years or can continue yearly screening
- Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer
3. Colon Cancer
- For people at average risk for colorectal cancer, the American Cancer Society recommends starting regular screening at age 45
- Stool testing should be done annually. Colonoscopy may be done at 10-year intervals if the prior exam is normal.
4. Cervical Cancer
- Cervical cancer testing should start at age 21
- Women between the ages of 21 and 29 should have a Pap test done every 3 years. HPV testing should not be used in this age group unless it’s needed after an abnormal Pap test result
- Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called “co-testing”) done every 5 years. This is the preferred approach, but it’s OK to have a Pap test alone every 3 years
5. Lung Cancer
- The American Cancer Society recommends yearly lung cancer screening with a low-dose CT scan (LDCT) for certain people at higher risk for lung cancer who meet the following conditions:
- Are aged 55 to 74 years and in fairly good health
- And have at least a 30 pack-year smoking history. (A pack-year is 1 pack of cigarettes per day per year. One pack per day for 30 years or 2 packs per day for 15 years would both be 30 pack-years.)
6. Prostate Cancer
- The American Cancer Society recommends that men make an informed decision with a healthcare provider about whether to be tested for prostate cancer
- Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment.
- We believe that men should not be tested without first learning about what we know and don’t know about the risks and possible benefits of testing and treatment
Primary Care 3.0 and molecular medical management
Eighty-five percent of American health care costs come from chronic conditions, such as cardiovascular disease and cancer conditions where early detection and treatment matter. Screening can identify these risks early. Early detection and evidence-based care using best practices can make a big difference.
Many in the broader medical community are aware that certain medications have a much bigger impact on cardiovascular events than their impact on the risk factor. If the doctor combines ACE inhibitors like lisinopril, statins like atorvastatin, metformin, and aspirin in high-risk patients with diabetes, there is a 4-fold reduction in heart attack, a 5-fold reduction in strong, an 11-fold reduction in cardiac stenting, and a 6-fold reduction in dialysis when compared with usual care.
New science says that those medications interfere with metabolic signaling that causes multiple chronic conditions including cancer. Metformin reduces cancer risk by about 40%. Type 2 diabetic patients, in general, have a lifespan of about 10 years shorter than nondiabetics—unless they are on metformin. If they are on metformin, they live a little longer than normal people. Primary care can provide molecular medical management today. You can bring better health to yourselves, your families, and your employees.
William H. Bestermann, Jr., MD
William H. Bestermann Jr., MD is a board-certified internist who has practiced preventive cardiology for more than 20 years. His core expertise is consistently producing optimal medical therapy (OMT) for cardiovascular and related conditions. He does this by using evidence-based care processes consistent with best practices.
He looks at OMT as a product. He understands how health care organizations can combine new systems, new science, and new payment models to produce that product much more consistently. That combination can be standardized, scaled, and industrialized. These new systems combine teams, protocols, population health tools, clinical/financial analytics, and provider training. Certain clinical interventions reduce clinical events more than they impact the target risk factor.
Dr. Bestermann has developed integrated protocols that combine those interventions which maximize impact on weight reduction, minimize drug interactions, and reduce side effects. When these systematic interventions are combined, they dramatically reduce the cost of care, prolong life, and delay cardiovascular events.
Dr. Bestermann wrote the first article on a systematic, integrated approach to the metabolic syndrome. He collaborated later with multiple academics and community leaders in a more detailed article on metabolic syndrome science and treatment. He proposed a new mechanism of action for metformin explaining its impact on cardiovascular, events, cancer, and aging.
He supervised an advanced medical home team within Holston Medical Group for cardiometabolic conditions that contained an ambulatory care residency for PharmDs. The team managed high-risk diabetic and hypertensive employees of Eastman Chemical Company.
He is also a senior clinical advisor for the Quality Blue Primary Care initiative at BCBS of Louisiana. That effort reduced hospital admissions, length of stay, and specialty referrals while lowering per member per month costs. He has personal experience producing OMT in multiple medical settings.
He has become convinced that only evidence, data, and transparency can deliver us from the low-value healthcare that prevails across the United States. There are many vendors making claims regarding their clinical and financial success. Most of those claims are not valid. Almost no one is consistently applying optimal medical therapy to patients with cardiovascular and related conditions in a way that prolongs life, delays cardiovascular events and reduces costs. Dr. Bestermann submitted his approach to the Validation Institute and received their stamp of approval.
In addition to being a contributing author for The Doctor Weighs In, Dr. Besterman also serves on the TDWI Editorial Board, where he medically reviews articles submitted for publication.
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