Everybody Wins

Everybody Wins
Marc Ringel

GREELEY, CO (2008-06-16)
The medical community is full costly and often times unnecessary diagnostic tests that may not yield conclusive results. But KUNC Commentator Dr. Marc Ringel says some tests are worth taking.

One of the premier principles of screening for a disease is that there has to be a treatment for the illness or else it’s not worth testing for. There are, for example, tests (not very well validated yet) that can suggest if a person is susceptible to developing Alzheimer’s Disease. Given that there is no known treatment for this horrible malady, nor any reliable way to stave off its appearance, what good could it do to know you’re likely get it? I can only see a downside, based on the panic that expectation of Alzheimer’s might inflict with every forgotten face or misplaced word. Another basic principle of health screening is that the disease being looked for needs to be prevalent enough that sufficient cases will be turned up. Otherwise, you might spend hundreds of thousands with little prospect of uncovering even one person to help. So, how come the State of Wisconsin has just invested half a million dollars for medical laboratory equipment and will spend another $400 thousand a year on supplies to add to its newborn blood screening panel a test for an illness that afflicts one in 65,000 newborns? In 2005 there were just 68,532 live births reported in that state. In other words, not even counting startup costs, Wisconsin would spend nearly half a million dollars to find just one case. The screening does makes sense when you consider the disease they’re looking for. It’s called Severe Combined Immunodeficiency Disorder (SCID), an affliction that cripples the immune system, leading, from early in life, to an existence fraught with suffering brought on by overwhelming repeated infections. Medical expenses for a person with SCID are estimated at $2 million, from cradle to premature grave. Testing for this affliction does meet the first principle of screening, that there be an effective therapy for the disease uncovered. In fact, SCID meets that criterion so well as to make it worth looking for, no matter how rare. Bone marrow transplantation is successful in curing 96% of infants of this immune disorder if accomplished before the age of 3-1/2 months. Since they already have a program that tests all newborns for other congenital diseases, any of which can cause untold misery if not diagnosed early, it’s easy enough for Wisconsin to add one more test to the panel. Thanks to amazing recent advances in biotechnology, the cost of an ultra-sensitive test for SCID is under $10 per individual. Admittedly, this program will not affect a lot of kids, about one per year in the whole state of Wisconsin. But everything about it is still right. That one baby is likely to live a long healthy life, instead of a brief miserable one. Imagine the benefits to this kid’s family too, having a well child instead of a chronically ill one in the house. And society is saved a whole lot of money. I can’t think of a better deal for the public at large, not to mention for the child and his family. It’s a great deal for us doctors too, at least psychologically, because, even in the dense thicket of disease screening and health economics, for once we have a clear-cut right answer.

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