Magazine

Beyond The Annual Physical


How much do you really want to know about your health? For most of us, the annual physical -- a little blood work, a little poking and probing -- will more than suffice. But for the well-heeled worrier, there are far more detailed and costly options: one- to two-day executive physicals that cost thousands of dollars, $500-and-up full body scans, and now, a $3,400 blood test named the Biophysical250 that screens for 250 possible diseases, at least 150 more than most standard physicals.

"Very American," my own admittedly skeptical doctor sighed when I told him I'd tried the latter option for this story. Then came the warning: "The problem with checking so many things is that you can end up spending a lot of unnecessary time and money chasing after abnormal lab results that are most likely meaningless." True, of course. And the test certainly flies in the face of current medical thinking, which holds that the commonplace annual physical is largely useless. Standard tests rarely uncover disease and have not been proven to prolong life. Yet a recent survey of primary care doctors found that 78% of their patients still expect a routine physical.

Some people want far more, and that's where Biophysical250 comes in. Available since last fall only from Biophysical Corp. of Austin, Tex., it is just one example of the quest for what could be seen as too much information. The company sends a nurse to your home to draw two tablespoons of blood, then the samples get shipped to Austin to test for everything from the mundane -- cholesterol and blood sugar levels, infection -- to the downright scary, such as dozens of proteins and enzymes that could indicate the presence of cancers, autoimmune diseases, or weird genetic anomalies. The test screens for 39 markers for heart disease alone. It does not, however, screen for diseases about which nothing can be done -- Alzheimer's and Parkinson's, for example. And most insurers do not cover its cost.

Biophysical250 is based on the fact that most diseases are caused by a number of factors gone awry in the blood. Biophysical figures it is far more likely to detect a potential problem by combining test results for a multitude of related disease markers rather than assaying just a few.

That sounds pretty scary if you don't give much thought to all the things that could go wrong with your body -- which could describe my "What, me worry?" approach. I hadn't had a physical for over four years when a Biophysical nurse arrived to draw my blood. Two weeks later, an impressively detailed binder of my results arrived in overnight delivery. I scanned the many, many, many numbers with some trepidation, but an hour-long phone consultation with a Biophysical physician, Dr. George Rodgers (part of the service), put most of my fears to rest. I have no signs of cancer, thyroid disease, diphtheria, metabolic syndrome, or lupus. I do have high LDL cholesterol, a surprise given that my readings had been normal in the past, but my own doctor wants to retest me before taking any action.

FALSE ALARM

I also have something new to worry about: a slight deficiency of alpha-1 antitrypsin (AAT), a blood protein that protects the liver and lungs. The test for AAT was developed only a decade ago, and it is sparsely administered. A serious deficiency, which is rare, can lead to emphysema and cirrhosis of the liver, two deadly diseases. My level was only slightly down, and since I've never smoked and am not an alcoholic, Dr. Rodgers told me I have nothing to worry about. Good to know, though, if I'm tempted to take up bad behaviors down the road.

On the other hand, I could probably go safely through life without being tested for AAT. All in all, Biophysical250 is a nice affirmation if you're fairly certain you're in good health, and an early warning system if you're not. Robert Crandall, former CEO of American Airlines, was one of the first to try it in a test run a year ago and says it confirmed what he already knew -- he's in great shape. "It's a great diagnostic tool," he says. Still, he has no plans to take it again. Why not? "Because they want $3,400 for it. Until the medical community says you need this full range of tests, I see no need to repeat it."

Crandall, and many other top executives, are more than willing to repeat an executive physical, the gold standard of checkups. At institutions ranging from the Mayo Clinic and Johns Hopkins University to a Canyon Ranch spa or other luxury resort, people who have plenty of money, or who work for companies willing to spend it on their behalf, can go though extremely comprehensive exams and lengthy doctor consultations to ferret out any disease or lifestyle problems. Most of these programs take two days and cost $2,000 to $8,000, depending on the tests ordered up and the luxuriousness of the surroundings.

LISTENING FOR CLUES

At the Mayo Clinic in Rochester, Minn., one of the first to offer executive physicals, the hallmark of the two-day exam is a lengthy initial meeting with a doctor. "We do run the standard evidence-based tests, but we also listen very carefully to the patient and pursue any clues they may give," says Dr. Deborah J. Rhodes, director of Mayo's program. She gives the example of a 37-year-old man who mentioned in passing that he recently noticed one testicle seemed smaller. This common asymmetry would have barely been noted, except that the patient said it was a recent change. As a result, Rhodes ordered a test for testicular cancer and discovered that the man had the very earliest stages of the disease, catching it long before it would have been found in a physical exam.

The patient might have detected the same cancer had he undergone another option for people who want to know every last thing about themselves, the total body scan. In this test, you are rolled into a computer tomography (CT) scanner, a sort of high-def X-ray, and it records every potential tumor in the body. The full body scan is held in low esteem by the medical establishment, however, because most of the clumps it turns up aren't tumors. Or if they are, they will never advance to a cancerous stage. In one study of smokers whose lungs were screened with a CT scanner, 74% had potential tumors, but only 4% turned out to have cancer.

I'll skip CT scanning. But while my doctor was checking out my Biophysical results, he scheduled me for a mammogram, colonoscopy, and bone density scan. I've officially joined the ranks of the health worriers.

By Catherine Arnst


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