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Last month we wrote about "Evidence - Based Medicine" in generally abstract, but laudatory terms.  Evidence medicine is providing the kind of medicine and medicines that has been proven to be effective.  Now comes a startling new development from the New Jersey that I read about in the Saturday November 25, 2000 Post and Courier.  The state which used to be home to many Seabrookers has mandated by law that certain evidence based medicine principles be required by law by the State's HMOs and health insurance providers.  In a nutshell, what the State law makers have done is required that participants in the various insurance coverage plans have an annual visit to the doctor and or other clinical provider for screening and health advice and counseling.  The state has said, if you want to do business in our state you will provide evidence based medicine that we deem appropriate.  This is truly a revolutionary concept and an experiment itself in preventive medicine worth watching closely.  Will New Jersey citizens benefit from this legislative prescription?
    
The Concept
Where did this idea come from and how did it become law?  The Department of Preventive Medicine and Community Health in the University of Medicine and Dentistry of New Jersey in Newark has for 30 years been doing research and setting up state-wide programs to improve health.  Dr. Donald Louria has spearheaded a health-promotion plan for the state which is based on proven methods of preventing and early detection of diseases.  The hope of this department is that the "Health-Full-Life" program will ultimately become national policy.  It has as of November become State policy. 
    
What is Required?
The table demonstrates the various tests and counseling that is provided.  Note that if you have read this column on "Heathy Aging" you will see that many of the things included in the screening have been advocated right here in the Seabrooker.  One thing that is interestingly omitted from this table is the well-known and proven benefits of exercise.  Also missing is use of the prostate cancer antigen blood test. Interesting other omissions are such routine screening tests as electrocardiogram and chest X-ray. Note that some of the tests are not mandated on an annual basis but less often - again based on scientific evidence.  An expert panel is to advise the state on changing what is and is not to be included on an ongoing basis.  It is hard to argue with the things included in the table, and Seabrookers would be advised to follow these guidelines as listed.  There are some things omitted, that I suspect Seabrookers' physicians would add.  

Is this the Right Thing to Do?
All of us  - individuals and governments and especially insurance companies should be concerned with maintaining health.  I commend the University of Medicine and Dentistry of New Jersey for addressing public health in such a public way.  This is not up for discussion.  The question is should the government dictate by law what the insurance companies and HMOs should do to practice health prevention medicine?  The danger  it seems to me is that if the legislatures start determining what constitutes appropriate medical care that the physicians and others who have the most knowledge in these matters may not be allowed to use their knowledge to the full benefit of all people, and even worse that the insurers now will have state law behind them to argue what should and should not be done for patients.   In New Jersey there is the additional problem that the only people covered by this law are those who have insurance and what about all the medicare/medicaid and uninsured citizens.  Has New Jersey actually created a two-tiered standard of medical care: one that mandates by law benefits for one segment of the state residence and that excludes others?  This New Jersey experiment will be watched very closely to see if the health benefits intended by law are found.  
 
Table: Tests and Counseling Required by HMOs and Insurance Providers*
Tests:
Blood Pressure: yearly after age 20
Blood Cholesterol: yearly after age 20
HDL Cholesterol: yearly after age 20
Pap smear: yearly after age 20
Mammogram: yearly after age 40
Stool examination: yearly after age 40
Lower bowel scope (colonoscopy): every 5 yrs after 35
Glaucoma: every 5 yrs after 35
Hemoglobin test: yearly after age 20
Blood sugar: yearly after age 20
Immunization update: all years

Counseling:
Breast  self-examination: monthly starting at 30
Testicular self-examination: monthly starting at 20
Weight: every month
Daily lower-back exercises: daily after 20
Smoking cessation: all ages
Seat belt use: always

*Required under New Jersery's new Health Wellness Promotion Act from University of Medicine and Dentistry of New Jersey as reported by AP in the Saturday November 25, 2000 Post and Courier.

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