From the desk of Dr Sam Shohet
BDS MGDS RCS(Eng) LiAc MBAcC ICAK
MEDICAL TESTS
The Questions
Blood tests, x-rays, MRI scan, CT scan, hair tests, saliva tests ……….., the list is endless and new tests come onto the market at a phenomenal rate; the latest as I write this is the new test for Alzheimer’s disease. But are these tests essential? What do they test? Can they deliver the right results? Will they do any harm? Is there a better alternative?
The Equipment
Perhaps the first thing we need to understand about any test is that some sort of equipment is nearly always required and, the second thing is that the results of the test must always be subsequently assessed by a real person and preferably an expert for that test.
Most testing equipment nowadays, apart from those producing images, are fairly sophisticated and rely on computerised electronics which produce readouts in the form of numbers or graphs or both. However, having said that, even equipment producing images such as MRI scans and x-rays also rely on computerised wizardry to interpret the images.
False Negatives and False Positives
As all test machines need to be calibrated on a regular basis and preferably before each test, it goes without saying that failure to do that could affect the outcome of the results. All machines also have their own margin for error, usually + (plus or minus) 10%. This means that if, say a reading of between10-15 were deemed normal, anything above 15 or below 10 would be abnormal and would therefore need treatment or intervention of some sort. So even if the test were carried out by a perfectly calibrated machine, 10% of 10 and 15 would give us figures of 9 and 16.5 respectively making this “normal reading” actually appear abnormal and the patient would receive unnecessary treatment as a consequence!
Measurements and Interpretations
Also, before any instrument is used we need to make certain what it is supposed to measure as many machines used in certain tests are recruited for other tests with the false assumption that the results would be just as valid. One simple example of this is a thermometer reading of temperature to test for signs of an infection when the raised temperature could be due to an overactive thyroid.
Once a test reading is obtained it must be interpreted by an expert and we all know that these interpretations are fraught with errors of false negatives and false positives. Even by viewing an x-ray the “wrong” way round could result in the wrong limb being operated on or worse still, amputated. A false positive for cancer is another example that could result in unnecessary and sometimes fatal consequences.
One Size Fits All
All that aside, perhaps the most serious downside of tests is that they are all so generalised (except the Integral Health hair test) and make the assumption that every individual on the planet is the same and do not take into account a person’s genetic uniqueness. This individuality means that under the same conditions each one of us will function differently.
Consequently, should a test show a “normal” result or reading, how can anyone be sure that their own reading needs to be higher or lower than this “normal” for them to be normal? And conversely, that an abnormal reading is perfectly normal for them and requires no intervention whatsoever.
What Now?
Bearing all this in mind, how should we proceed with this very intricate and convoluted system and should we subject ourselves to medical tests at all?
The answer depends on whether the tests are required for an emergency where there is an immediate threat to life or limb, or for a chronic condition with no imminent threat and there is time to consider the options. In an emergency there is absolutely no question that conventional medicine saves lives and this is certainly not the time to be concerned about the appropriateness of tests.
However, when there is no imminent danger it is worthwhile to assess the situation realistically and logically without any pressures from outside quarters and well-meaning do-gooders.
Test Suitability
When considering the suitability of a test we have to take into account the trade off which is inevitable between the knowledge gained from the results of the test and any side effects of the test itself and possible ramifications.
Non invasive tests such as saliva, hair, urine, faeces, temperature, blood pressure etc do not generally pose a problem; we need only decide whether the results are relevant.
Hair Mineral Analysis
Take for instance a hair mineral analysis which shows low zinc and high calcium. Does this mean that we should take zinc supplements to redress the balance? If so in what form: ascorbate, oxide, picolinate, sulphate etc? Is this low zinc the result of there not being sufficient zinc in our diet or that there is a problem with absorption of the zinc from the gut for whatever reason? Or perhaps that excess iron and/or copper in the system is suppressing the levels of zinc?
What about the raised calcium? Are we taking in too much calcium from our diet or supplements or is it perhaps not being taken up and used by the body? Or is it even conceivable that our skeleton where 98% of calcium is contained is actually dissolving and no longer retaining the calcium?
Toxic Metals Analysis
Toxic metal hair analysis presents similar problems of interpretation. Does finding high levels of mercury and lead mean that we are being poisoned by someone or that our body is not able to eliminate these metals? Are these metals coming from within the body or is it from a hair dye or shampoo/conditioner? Should we concentrate our efforts on active removal of the metals or supporting the body’s detoxification system?
More Questions Than Answers
If tests end up creating more questions than answers then surely there is no point in doing them which at best adds to the confusion and at worst actually creates it. But at least these types of tests are harmless yet show the patient that something ‘scientific’ is being done and we all love science even if sometimes it tells us nothing.
Side Effects
Blood tests and visual scans such as x-rays, MRI, CT, mammograms etc do have side effects and complications and are snapshots in time and do not indicate the progress of a disease process. But then sometimes all that might be needed perhaps is a snapshot and there is no need to establish whether something is getting better or worse or even staying the same.
Invasive Tests
As for invasive tests including biopsies, ‘-scopies’ of any kind (endoscopy, laparoscopy and so on) etc with their catalogue of possible problems, sometimes even fatal, it is important to be realistic and take a more philosophical view. I always recommend my patients who ask me for advice on whether they should undergo any such tests to run through a systematic list of “what if”.
A Case Illustration
As an illustration let us take the scenario of discovering a lump anywhere in the body.
A Lump
The medical procedures in this case are standard and will be to diagnose the nature of this lump, whether it is benign (not likely to invade or spread) or malignant (likely to invade or spread). The treatment for the latter would depend on whether the tumour is locally invasive only or likely to metastasise (create cancers elsewhere in the body) and whether it is a primary (the original tumour) or a secondary (from the spread).
Worst Case Scenario
As I always recommend, let us consider the worst case scenario:
What if the lump turns out to be not only malignant but also a secondary (it has come from a primary which has obviously spread). The standard treatment will then involve mass x-ray investigations to locate the primary, possible surgery to remove the primary, secondary, lymph nodes etc, prolonged chemotherapy, radiation to the site of the primary, subsequent reconstructive surgery and the usual drug therapies to deal with the side effects of the treatments and their own side effects (all drugs have side effects).
What If?
What if the chances of survival for 5 years with this treatment were put at 50/50, 40/60, 30/70?
What if the best prognosis even after surviving for 5 years would leave you incapacitated in some way? Or even totally incapacitated?
What if the chances of survival without any intervention whatsoever were pitched at 3 years instead of 5 with the treatment?
What if there were alternatives?
What if these alternatives added a few extra months or years to your survival but without the inevitable suffering – called bravery – with conventional treatment?
Should you decide that you want to be brave and would rather go the conventional route; the tests are part and parcel of the treatment package.
Should you choose not to be cut, burned or poisoned, surely there is little sense in having the tests at all since natural medicine treats the whole person and not a specific part, condition or disease.
Only One You
Remember always there is only one you. You are the most important person and no-one can look after you better than you. So make sure you do not get bullied or frightened into making the wrong decisions because after all, you are the one who will have to live with the consequences.
Warm regards,
Sam Shohet