Chaos 1
Gene sequencing predicts all diseases.
With 99.99% gene accuracy, a drop of blood can tell the risks of all diseases, and more than 1000 genetic diseases can be found ... On the Internet, gene sequencing has been "blown" to be almost omnipotent, which can not only predict diseases, but also predict the amount of drinking, whether there is a tendency of puppy love and internet addiction.
Recently, the reporter's investigation found that some institutions claimed that gene sequencing can "test all diseases" and even "cure all diseases"; Some institutions also say that gene sequencing can detect "natural genes" and realize "teaching students in accordance with their aptitude". Under the guidance of this concept, individual hospitals have carried out "dominant gene detection" and "disease susceptibility gene detection" projects.
The fees for gene sequencing are also very confusing. Some institutions spend about 380,000 yuan to do a whole gene sequencing, claiming that they can scan and arrange more than 20,000 genes in the human body. Some "genetic testing" physical examination packages cost 76,000 yuan, while the price of testing only 68 genes costs 34,000 yuan. Of course, there are also cheap basic packages for 125 genetic testing, and the price is only 1000 yuan.
It is understood that gene sequencing is mainly aimed at the examination of genetic diseases, and auxiliary diagnosis or genetic counseling is carried out through gene detection technology. For example, when two deaf people get married, it is theoretically possible to predict the health status of their children through gene sequencing. Alternatively, genetic testing can be used to predict the incidence of diseases. For example, Angelina Jolie, a movie star, was told after gene sequencing that she had a genetic defect and was at higher risk of breast cancer and ovarian cancer. Therefore, she chose to remove both breasts, hoping to minimize the risk of breast cancer.
Wu Xueyan, chief physician of Endocrinology Department of Peking Union Medical College Hospital, said that it is meaningless without targeted gene sequencing, and it is not recommended to take gene testing as a routine physical examination item at this stage. At present, there are three main contents of genetic examination, which include not only predicting the risk of genetic diseases, but also making clear diagnosis and guiding drug use. The latter two items can be completed by means of fluorescence quantification, chip and other examination methods. In addition to scientific research, we also provide gene sequencing services for some cancer patients who need targeted drugs to determine more effective drug programs. "People with a family history of cancer can receive gene sequencing, judge their risk of cancer, and receive health management as a high-risk group. But in all breast cancer patients, the proportion of genetic factors is very low, and the proportion of cancer caused by gene mutation is also very low. It is not yet possible to accurately judge who will develop breast cancer in people with the above genetic mutations. "
Wang Zhong, vice president of Tsinghua Chang Gung Memorial Hospital and head of the Health Management Center, also said that there are congenital factors (genes) that determine a person's life and death, but more are external environment and acquired factors, such as living habits, physical effects of the environment and microbial effects. Even from a genetic point of view, people with the same pathogenic genes need other pathogenic factors to get sick. It seems that it is not objective enough to explain that a person will get a certain disease simply from genetic testing. In addition, genes can only explain the possibility of suffering from a certain disease, which is often expressed as a percentage. This kind of expression often brings great psychological pressure to ordinary people. Therefore, the role of genes in health management needs further discussion.
Chaos 2
There are many physical examination items.
Mr. Zhou, 60, lives in Fengtai District, Beijing. His original lifestyle was not healthy enough, and he felt uncomfortable without smoking or drinking every day. However, in the time after retirement, his state has undergone subversive changes-it is not a taste to "send away" several old colleagues in just a few years. Because he didn't want to repeat the same mistakes, Mr. Zhou began to undergo an annual physical examination, hoping to find health problems in advance. However, he found that there were more and more physical examination items. "In the past, there were dozens of medical examination items, but now it has increased to nearly 100 under the introduction of the staff of the medical examination center, and the price is getting higher and higher, nearly 10,000 yuan."
The reporter saw on the website of a well-known private medical examination institution that the medical examination institution has launched more than ten kinds of packages for different consumers, and its website clearly marked that the first step of the medical examination process is to design a medical examination plan for experts. Then the reporter contacted the customer service of the medical examination center. After simply asking about age, gender, smoking, etc., the customer service recommended the B package with the price of 1000 yuan for the reporter. In another medical examination institution, the reporter also consulted as an ordinary consumer, and the customer service staff recommended a 3,000 yuan medical examination package for the reporter after a simple inquiry.
In a medical examination institution, the reporter also found that the price of a medical examination package is as high as 1.73 million yuan, covering clinical medicine, medical imaging, functional medicine, genetic medicine and other fields, claiming to prevent ultra-early cancer, screen the twelve major causes of sudden death, prevent and control chronic diseases, and "decipher the genetic code of the body and predict the future health trend". The software package also claims that it can assess the risks of 68 diseases in 9 categories (including tumor diseases, cardiovascular and cerebrovascular diseases, diabetes, liver diseases, drug sensitivity tests, kidney diseases, blood system diseases, immune metabolic diseases and psychophysiological diseases).
Wang Zhong reminded that many diseases have no obvious manifestations at the initial stage of onset, but abnormalities can be found through appropriate physical examination items. But physical examination is not necessarily the best, because of the high cost or many items. Physical examination should be combined according to different people's age, occupation and family history. Non-disease population, it is recommended to receive a basic examination once a year to investigate health risks; Patients with confirmed diseases should shorten the physical examination time, preferably once every 3-6 months. For the non-disease population aged 18 to 35, the general basic examination package is enough; People aged 35-45 suggest adding age-appropriate items such as bone mineral density, cardiovascular disease and tumor to the basic examination package; In addition to basic examination, it is suggested that people over 45 years old should be screened for chronic diseases such as diabetes, tumor, coronary heart disease and stroke.
Chaos 3
Some routine physical examination items are not reliable.
Compared with the "high-end" genetic physical examination, ordinary people are most exposed to routine physical examination, but recently a widely circulated "five most unreliable physical examination items" online post has disrupted many people's physical examination plans. In this list, X-ray examination of lung cancer, color Doppler ultrasound examination of prostate cancer, blood calcium examination of calcium deficiency in children, CT examination of breast cancer, infrared examination and laboratory indicators of gastric cancer are all on the list.
X-ray examination of lung cancer is widely regarded as one of the most widely used examination methods with the highest missed diagnosis rate. Xuanwu hospital, director of the Department of Thoracic Surgery, Capital Medical University, said that because the resolution of chest X-ray is very low, the detection rate is also very low, and sometimes it may be late, so experts suggest using high-definition CT to check lung cancer with high resolution. This is also a common method in Europe and America at present, and the detection rate is as high as 90%. Therefore, it is recommended that middle-aged and elderly people or friends with a family history of lung cancer change X-rays into CT.
A 40-year-old man often has an abdominal color ultrasound in physical examination, and there is also a "Qiancai"-prostate color ultrasound in physical examination to screen whether he has prostate cancer. Zhang Zhichao, chief physician of the andrology center of Peking University First Hospital, said that Qiancai could not detect early prostate cancer, and there was no way to judge whether it was benign hyperplasia or prostate cancer. Color ultrasound examination of prostate is more effective for patients with serious illness, but useless for latent or early cancer. If it's just a routine physical examination, it's completely unnecessary.
Zhang Zhichao introduced that prostate specific antigen (PSA) project is more reliable for screening prostate cancer. PSA is cheap, which can eliminate the problem of false positive (prostatitis and urinary tract infection will lead to the increase of PSA value). It is the most convenient and sensitive method for early screening of prostate cancer. When the PSA level in blood exceeds the normal value (more than 4 ng/ml), you need to be highly vigilant and go to the hospital to see a specialist in time. "It is best for men over 50 to check PSA every two or three years, because if it is prostate cancer, this value will be higher. Generally, when screening, we must first understand whether it is benign hyperplasia or malignant hyperplasia, that is, check PSA first. If PSA is high, further examination is needed at this time, and nuclear magnetic resonance is the first choice. "
Blood tests for calcium, especially for children, are also of special concern to many parents. They can judge whether there is calcium deficiency by measuring trace elements in blood. Is it reliable or not? Wang Yunfeng, chief physician of pediatrics in China and Japan Hospital, said that trace elements should not be used as routine physical examination items for children, and their accuracy is not so high. After the results are found out, you should never judge whether the child is zinc-deficient, calcium-deficient or iron-deficient according to such a test sheet. Be sure to ask about the medical history, because the calcium in trace elements is total calcium. If the child is really calcium deficient, his free calcium should be deficient.
In addition, as early as 20 13, the National Health and Family Planning Commission issued the Notice on Regulating the Clinical Detection of Trace Elements in Children, clearly stating that "it is not necessary for diagnosis and treatment, and it is forbidden for medical institutions at all levels to carry out trace element detection for children who have not been diagnosed and treated."
Wang Yunfeng said that trace element detection is not recommended as a physical examination for children. Generally, this is only done when something unusual happens, but it is for reference only. We can't judge the health problems only by the test results of trace elements, but also need to comprehensively evaluate the feeding history and clinical symptoms. In addition, objective factors such as personnel operation, detection methods and equipment will also lead to deviation of the results. "For example, measuring hair actually reflects the growth situation in the first three months and cannot be used as a judgment now."
The sensitivity and specificity of CT and infrared detection of breast cancer are low. Wan Donggui, chief physician of the Department of Oncology of Integrated Traditional Chinese and Western Medicine in China-Japan Hospital, pointed out that when CT is used to detect breast cancer, it has some shortcomings, such as low sensitivity and low specificity for breast. In addition, infrared detection is not recommended in some places, because infrared detection is not an international standard, with poor machine performance, low sensitivity, large error and strong subjective judgment of doctors. Now big hospitals don't use this method for testing.
Experts suggest that for early screening of breast cancer, self-examination and B-ultrasound or molybdenum target examination should be carried out first. Compared with breast CT, magnetic resonance examination is obviously better, but because of its high price (about 2000 yuan), it is only recommended in high-risk groups (such as obese women with family history of breast cancer and breast diseases).
The accuracy of laboratory indicators in detecting gastric cancer is low. Laboratory indicators include hematocrit, hemoglobin, fecal occult blood, gastric juice and other items, which are often used to prompt the health status of the stomach in physical examination. Experts said that these indicators can be used for the preliminary screening of stomach diseases, but if they are used for gastric cancer screening, their accuracy still cannot meet the requirements.
Experts suggest that gastroscopy is the most standard and accurate, and it is the first choice for screening and diagnosing gastric cancer. However, gastroscopy is relatively expensive, painful and invasive. So if the first gastroscopy is benign, it can be done every five years. However, if the physical examination results show that there are patients with heterosexual hyperplasia (such as inflammation), atrophy, gastric ulcer or family history of gastric cancer, besides treating these diseases, it is best to have a physical examination interval of 2-3 years.
Matters needing attention in physical examination
Physical examination should take "1+X"
"First-class environment, second-rate personnel and third-rate service" is often used to describe some current health check-up institutions, which are characterized by the lack of scientific explanations and personalized medical package design suggestions before physical examination, the lack of unified and standardized professional service processes and paths during physical examination, and the lack of health assessment and follow-up management after physical examination, which greatly reduces the "health output" of health check-up.
Wu, chairman of the Health Management Branch of the Chinese Medical Association, pointed out that the current problems in China's health examination are ultimately due to the lack of standardization in China. According to him, in August 2009, the Ministry of Health issued the "Interim Provisions on Physical Examination Management", but the corresponding list of basic physical examination items, implementation rules and procedures have not been issued. "No rules means no operability."
Then, how to choose a set meal during physical examination, and what should I pay attention to?
Zeng Qiang, director of the Institute of Health Management of the PLA General Hospital, pointed out that at present, the "two ends" of physical examination in China are not enough. First, the questionnaire survey before physical examination and the recommendation of different physical examination schemes for different answers; The second is health management after physical examination. Zeng Qiang told reporters that the mode of "1+X" should be adopted in health examination. 1 is a basic physical examination item, and it is also a necessary item to form a health examination report and personal health management files, including health examination self-test questionnaire and physical examination. , involving routine examination of hematuria and stool, otolaryngology, dentistry, stomatology, gynecology, electrocardiogram and so on. The "X" refers to "special physical examination items", which are mainly aimed at individuals with different ages, genders and chronic disease risks.
Wu said that consumers can refer to the Expert Knowledge of Basic Health Check-up Items released in May 20 14 when choosing a medical check-up package. According to reports, "* * * knowledge" clarifies the mandatory and optional physical examination items. Among them, physical examination items are divided into three categories: the first category is physical examination, such as height, weight, waist circumference, hip circumference, blood pressure, internal and surgical examination, eye examination and so on. The second category is laboratory examination, including general examinations such as blood routine, urine routine and stool routine, as well as biochemical examinations such as liver function, renal function, blood lipid and blood sugar, as well as gynecological cytological examination; The third category is auxiliary examination, such as electrocardiogram, X-ray examination and ultrasound examination. The self-test questionnaire of health examination has also been determined as a compulsory item in knowledge.
Wang Zhong also said that an effective physical examination should generally choose a menu that is more suitable for my physical examination based on comprehensive factors such as age, gender, living habits, personal past health status, family history of hereditary diseases, recent situation and lifestyle. Under special circumstances, items can be appropriately increased to obtain more comprehensive health information.
Wang Zhong also reminded everyone to pay attention to the following three points when choosing an experience institution.
First of all, the qualification of the medical examination center must be excellent, the medical examination personnel of the institution should be professional, and the medical staff should have a practicing certificate and have many years of medical experience; The equipment should not only be advanced, but also be audited every year to ensure the accuracy and truthfulness of physical examination data.
Secondly, improve the follow-up health management services. Expert guidance and consultation before examination, analysis of physical examination report after examination, etc. You need an authoritative doctor to serve you. Whether the medical examination institution has a complete follow-up service system is also one of the conditions to be considered. At the same time, it is best to have a large general hospital behind the medical examination institution as the support of medical technology.
Finally, the physical examination institution should set a clean and comfortable physical examination environment for the examinee, and the physical examination area of the physical examination institution should be relatively independent to prevent cross-infection.
Do a good job in health management after physical examination.
Speaking of physical examination, most people may think of such a scene: many people line up, which physical examination items to do, go to the corresponding departments one by one, and then get the physical examination report every few days. After getting the medical report, see if all the indicators are normal. At this point, the whole medical examination process is over. However, Wang Zhong said that the physical examination is only the first step, and the medical staff will provide each medical examiner with a personalized physical examination plan and do a good job in health management.
"Physical examination institutions should strictly prohibit medical examination reports of thousands of people, require personalized medical examination reports, and put forward targeted and concrete suggestions for physical examination, that is, health assessment and intervention for physical examination." Wang Zhong said, "If you don't interpret and intervene after the physical examination, the physical examination will lose its meaning."
The contents of the interpretation of the experience report mainly include whether the functions of various organs are normal, the risk of illness, and the general prediction of health status in the next few years, so as to intervene and manage the medical examinees. For example, after the medical examiner completes the cardiovascular assessment, the doctor will clearly explain the incidence of stroke and the risk of myocardial infarction in the next few years, and then suggest going to a general hospital for further examination and making specific suggestions on living habits.
However, some people only pay attention to the physical examination process, but ignore the reading of the physical examination report. Some people who find out serious problems will take the initiative to seek medical treatment, but more people get the medical report and throw it aside. Even if I read it, I only skim it, and I don't agree with the medical reports, especially the medical conclusions and related suggestions. Wang Zhong said that many physical examination reports clearly indicated that the examiners had major disease diagnosis or abnormal positive results, and the doctors also gave clear guidance and suggestions. However, because the body was not unwell for the time being, it did not attract the attention of the medical examiner. The timely detection of major diseases was delayed, the symptoms were advanced, and the best treatment opportunity was missed.
Author: Jane Yi Qian Yuyang