Here is a couple of examples of such tests and interventions:
-- Only confirmed heart attack victims are put on ACE inhibitors, not all potential victims.
-- More reliable, non-routine, coagulation tests are performed only on people who have already suffered blood clots in their legs or lungs, not on all potential victims of such and more dangerous clots.
Probably because
1) not been demonstrated to be of value in primary prevention
2) economics
It seems because physician are not very much convinced about the benefit of drugs especially in primary prevention and it is difficult to convince the patients to take medicine for any future event that may or may not occur.
Don't think the initial statement is true.....
'preventative tests' are never 100% accurate, bring up false positives and false negatives, are often difficult to interpret for an asymptomatic population and will raise issues of the risks of subsequent intervention in a healthy individual. Coagulation tests are fraught with interpretion problems, and no clear consensus regarding interpretion - as well as being expensive!
'preventative interventions' all carry some risks, including treatment-related death, and need to be justified by best evidence from trials. If clear evidence is available, if the risks are minimal and the cost is justified, then the issue of public acceptance of administration of a potentially harmful substance would be considered (flouride in water). The balance of risks for ace-inhibitors makes the intervention less acceptable.
Thank you for you comment, Dr. Lee. And I am probably oversimplifying, but as far as I know an elderly patient exhibiting multiple risk factors for a heart attack, will not be put on ACE inhibitors until he has a heart attack. Similarly, a patient with multiple risk factors for thrombosis (but with unknown rate of coagulation) will not be sent for certain (I am not sure which ones) anti-coagulation tests which are more reliable than a routine platelet count, until he gets a major thrombosis. ... But I may be wrong.
You would treat the treatable risk factors! If the patient has hypertension and heart failure they may be put onto an ACE inhibitor, or a more suitable anti-hypertensive.
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