Dearest: My guest tonight is David Johnson, Ph.D. an associate professor and Chairman 
in the Department of Physiology at the College of Osteopathic Medicine, University 
of New England, Biddeford, Maine. Dr. Johnson is the co-author with David Sandmire, 
M.D., of the new book, "Medical Tests That Can Save Your Life: 21 Tests Your Doctor 
Won't Order ... Unless YOU KNOW To Ask."

Breakthrough medical tests can find dozens of deadly diseases before it's too late. 
But because of the state of modern healthcare (with insurers' red tape and doctors' 
busy schedules), most of us don't know that these tests are available let alone which 
ones to have, what they're called or how to ask them. That's all about to change.

Dr. Johnson, it's a pleasure to welcome you to Power Surge.


Dr. David Johnson: I'm very happy to be here.


Dearest: Dr. Johnson, you say in your book, "According to a recent study, one in 
three doctors withholds information from his patients that could benefit them. 
In particular, this means that these doctors may not tell their patients about 
screening tests that could detect potentially fatal diseases in early, treatable 
stages."

Can you share with us WHY any doctor would withhold this type of information
from a patient, especially if the doctor is aware that the patient might be able
to avoid serious health problems? 


Dr. David Johnson: One of the reasons, unfortunately, is that if they know the 
patient's insurance company won't cover that procedure and they know the patient 
they can't afford it, they might might conclude that it's best just not to discuss 
it. Another reason is that they may believe personally that the procedure or the 
test is of no value to that particular patient's condition.

Finally, the HMO that that patient belongs to may not allow the doctor to discuss 
that procedure because they don't pay for it.


Dearest: I have a condition called Costochondritis and requested of my HMO family 
practitioner to have a digital mammogram instead of a regular mammogram because
of the pain to the breast bone. My doctor refused. He said the HMO wouldn't pay
for it. I called my HMO's executive offices and got them to agree that I could
have it. Do patients often have to go beyond their doctors to get what they need?


Dr. David Johnson: That's very true. Patients very often need to go beyond their 
doctor to look out for their best interest. Your doctor is very busy, may not know 
everything there is to know about that particular condition, and is under financial 
constraints to contain the cost of treating it.


Gramz: What do you think of the C-Reactive Protein and Homocysteine for a 
postmenopausal patient? Do you feel these are beneficial test when cholesterol, 
triglycerides, LDL and HDL are normal?


Dr. David Johnson: The answer to that is a definite yes for the C-Reactive Protein 
and possibly yes for the plasma homocysteine. A high plasma level of C-Reactive 
protein is definitely a risk factor for coronary heart disease independent of 
cholesterol.


Dearest: Something that seriously concerns me is that doctors are given "test 
results" by a laboratory, and included are values or normal and abnormal ranges. 
However, often those results are only numbers and I've personally experienced more 
than one doctor who looked at abnormal test results and said, "Everything is fine." 
I know because I followed up after seeing the results myself. Do you think doctors 
are always educated enough about test results, or perhaps patients should be 
discussing their test results directly with the physicians at the lab.


Dr. David Johnson: Normal lab values are only averages. What's normal for one person 
may not be normal for another person. The reality is the lab that does the test 
decides what's normal and what's abnormal on certain studies. What some labs consider 
normal compared to other labs varies throughout the US. So the moral to this story is 
that any lab value that's in the high range of normal should be considered suspicious 
if other factors suggest disease is present.


Dearest: Isn't it possible to have "universal" ranges?


Dr. David Johnson: Medical laboratories are standardized, but some labs will consider 
a normal value to be different from another lab because they may be using information 
from more recent studies.


AnnieOakl: Is there a way to make the HMO or insurance company pay for tests we 
want/need? Or do we just keep bugging them until they approve a test?


Dr. David Johnson: You can often get them to approve a test if you can show you 
have above average risk factors for the disease that the test looks for. However, 
many tests are inexpensive and you would benefit more by paying to have the test 
done as opposed to not having it done simply because the HMO won't pay for it.


AnnieOakl: Do I tell them or my doctor?


Dr. David Johnson: You should ask your doctor first because if your doctor believes 
your situation warrants it, he or she may code the problem in such a way that the HMO 
will pay for it.


GlendaS: If we are not being given the tests, treatments, pain relief that we should 
be getting, what can we do about this? Are there organizations to go to for help or 
are we stuck filing lawsuits?


Dr. David Johnson: If you're not being given the tests, medications and pain relief 
that you should be getting, that could be due to several factors. One of these is 
that your doctor simply is not aware of the fact that the test exists, that the test 
is of any value, or that you're experiencing clinical pain beyond what's acceptable. 
The other possibility is that your doctor knows about the tests but simply doesn't 
think your HMO will pay for it, or doesn't know how much information it can provide 
and therefore, simply doesn't order it.

In the case of pain, if you're telling your doctor that you're in pain and he or she 
refuses to change or increase your pain medication, you need a new doctor.

Keep in mind that in this book what we're advocating is using specific conventional 
medical tests in unconventional ways. In particular, the tests that we discuss in 
this book. In other words, the tests that we are discussing in this book are 
generally used only to diagnose or stage disease in a person who already has symptoms 
of the disease. These tests are abnormal in many cases long before symptoms appear. 

If you are at high risk for the diseases we discuss and choose to have the tests done 
before you have symptoms and find that you in fact have the disease, your chance for 
a cure or a good prognosis will be greater.


Dearest: Which brings me to a question about the full body CT scan, which has become 
very popular lately among those who can afford it. However, you don't endorse it for 
everyone. Under what circumstances will you recommend or not recommend a full body
CT scan? 


Dr. David Johnson: I would recommend a fully body CT scan under NO circumstances. 
This is what I call a true fishing expedition. It's much more effective to examine 
specific parts of your body for disease based on your risk factors than to take a 
"spray the infield approach: with high doses of radiation in the hopes of finding 
a cancer in the early stages. This is particularly true in people who do not have 
family histories or risk factors for cancer. Finally, a very recent study confirmed 
that the doses of radiation received in a full body CT scan are equivalent to the 
doses received in some atomic bomb survivors.


MaryO: Dr. Johnson, I had a rare disease. I did a lot of research and asked doctors 
to test me for it, yet none did. Even though it was "rare", it doesn't mean that no 
one gets it. How can we get doctors to test for these rare diseases, especially when 
a patient has done the research and has many symptoms? I wasted years before my 
diagnosis and surgery. 


Dr. David Johnson: What is the disease you're referring to?


MaryO: Cushing's disease caused by a pituitary tumor.


Dr. David Johnson: Cushing's isn't all that rare. The definitive test to diagnose 
Cushing's disease cost less than $100.


MaryO: According to the doctors I saw over several years it was too rare to get.


Dr. David Johnson: Missing Cushing's disease is inexcusable. If you have a worry 
about a specific disease, you're educated about that disease, and the test for the 
disease is accurate, low or no risk and inexpensive, there's simply no excuse for 
not testing for the presence of the disease, especially if any clinical symptoms 
are already present.


MaryO: That's what I thought, too, especially when I asked to be tested.


Stella0324: Dr. Johnson, Do you recommend a colonoscopy for everyone over 50
as a screening test? I'd much prefer to avoid it if I can but still worry about 
missing cancer, should I have a virtual colonoscopy? 


Dr. David Johnson: Everyone should in fact get a screening colonoscopy, a full 
colonoscopy, not a sigmoidoscopy at age 50. Colonoscopy remains the gold standard 
for detecting colon cancer and its precursor, pre-cancerous polyps. Virtual 
colonoscopy has a lot or promise, but is still not as effective as a full colonoscopy 
for preventing and detecting colon cancer. If anyone in your family has had colon 
cancer, you should have a full colonoscopy in your 40s.


Dearest: What's the difference between a colonoscopy and a virtual colonoscopy? 


Dr. David Johnson: A virtual colonoscopy is a very effective radiographic study of 
the colon. Unlike a barium enema, it much more easily tolerated and is in fact an 
alternative to people who simply cannot tolerate a regular colonoscopy. However, 
studies have shown that the colonoscopy remains your best bet for detecting early 
colon cancer, precancerous polyps.


Gramz: What about colonoscopy? My mother had colon cancer at 49 years of age.
Today she is 81. I am 53 and my doctor said since my colonoscopy was clear 4
years ago that she thinks just a sigmoid is needed this time. I think I should
push for a colonoscopy with a gastroenterologist. Do you agree? 


Dr. David Johnson: Sigmoidoscopies miss 60 percent of all colon cancers. They only 
examine the first two feet or so of the colon. And only 40 percent of all colon 
cancers occur within the reach of the sigmoidoscopy, therefore, you absolutely should 
insist on having a full colonoscopy and do not give in on this one.


Dearest: Power Surge is a community for women at midlife in all phases of menopause. 
What tests do you think are essential for women in this age group?


Dr. David Johnson: Definitely the tests we describe in the book for evaluating risk 
of coronary heart disease. In addition, you should absolutely have a baseline DEXA 
scan to evaluate bone density. If you have a strong family history of breast cancer 
based on the criteria that we describe in the book, you should consider BRCA genetic 
testing for hereditary breast cancer. This is also true if you have a strong family 
history of ovarian cancer because having a BRCA gene mutation greatly increases the 
risk of ovarian cancer in addition to breast cancer. Finally, if you have long 
history of smoking, you should read the chapter on spiral CT scanning for the 
presence of early lung cancer.


Twink1: Hello Dr. Johnson. My partner has hepatitis C, chronic fatigue, type 2 
diabetes, polycythemia vera (PV), and nerve damage in his legs. He has had MRI's CT 
scans, several blood tests and we are not getting anywhere as far as treatment goes, 
except for the PV, which he takes Hydroxyurea for. Are there any other tests you 
could suggest? And/or would you recommend Interferon/combo treatment? He is in 
chronic pain, bedridden 24/7, no quality of life. Thanks 


Dr. David Johnson: The diseases you described have varying degrees of symptomology 
and are all relatively treatable by an experienced physician. His neuralgia or leg 
pain as you know is almost certainly due to his diabetes which, if is not under 
control, should be referred to an endocrinologist. 

His hepatitis C is also generally manageable depending on which stage of the disease 
he's in. This particular disorder should definitely be evaluated by an experienced 
gastroenterologist. 

Finally, if he hasn't already seen one the PV should be evaluated by a hematologist. 
You primary care physician should provide him with these referrals if your quality 
of life is not good.


JaneJ: Dr. Johnson, what are some of the other tests you feel are essential?


Dr. David Johnson: The answer to that question is dependent on your risk factors. 
When you read the book you'll be able to evaluate your individual risk for many 
serious diseases that are common to both men and women as we age. In addition to 
those that are much more common only to post-menopausal women.

So for example, if you have someone in your family that's ever had an abdominal 
aortic aneurysm you definitely should have an abdominal ultrasound; however, a woman 
with no family history of an abdominal aortic aneurysm does not necessarily need this 
screening test. I might add having an occasional abdominal or pelvic ultrasound will 
pick up liver, gall bladder and kidney problems as well.


Loon777: I am 61 years old, had a colonoscopy last year, had one polyp removed, all 
was ok, next one will be done in 5 years. If you have one polyp or more removed, are 
there chances of more developing over the 5 years?


Dr. David Johnson: Was it a pre-cancerous polyp or not?


Loon777: Pre-cancerous


Dr. David Johnson: I would suggest you have another one in three years because they 
can grow back.


Loon777: At least I think it was, they said it was nothing to worry about.


Dr. David Johnson: Then it probably was not pre-cancerous, which is why they 
recommended re-examine in five years. I would ask your doctor to confirm whether 
it was pre-cancerous or not. If it was, ask to be re-examined in three years.


Loon777: Oh ok. My Dad had colon cancer and was cured and lived another 15 years 
after and died of a heart attack. 


Dr. David Johnson: 90 percent of colon cancers are sporadic and not due to genetic 
predisposition. So the chances are your dad's colon cancer was not genetically 
predisposed, especially if he got it when he was over 50 years of age.


Dearest: Dr. Johnson, if doctors don't stay on top of the most current medical 
information and tests, how can patients be expected to know everything? Many women 
(and men) take their doctors' word as almost God-like. Why should doctors have to be 
educated by their patients? 


Dr. David Johnson: Like you, your doctor is only human. Medical science and medical 
therapy are evolving at an extremely high rate and doctors who are overwhelmed with 
patients and paperwork simply cannot be expected to be completely updated on all 
medical information, and in fact, are not. Therefore, you should work with your 
doctor as your partner in your healthcare. And as a partner you would be wise to 
provide your doctor with information about your particular medical history, 
lifestyle, or symptoms so that the best possible outcome can be obtained for a 
problem that might exist.


Gramz: My sister was diagnosed with mastocytosis 8 years ago and today has mast cell 
leukemia (she is only 63). Do you know anything about this disease? I understand it 
to be fairly rare? Or is it something my children and I should be concerned about?


Dr. David Johnson: It's highly unlikely that she or her children need to be concerned 
about it, but the definitive answer and peace of mind will come if she has a consult 
arranged with a hematologist.


Gramz: She is in a protocol at NIH as well as being seen at UC Davis medical center.


Dr. David Johnson: The question that you just put to me should be put to your 
sister's hematologist at UC Davis who I think will assure you this is unlikely 
to be a problem for you.


Dearest: In your book you talk about the "etiquette of gathering your family health 
history." Can you elaborate on the easiest way of going about this?


Dr. David Johnson: First of all, make sure that family members realize that you're 
gathering this history only because it could make the difference in your own personal 
health and secondly, and even more importantly, when a family member tells you that 
grandpa, let's say, died of lymphoma for example, that you get the hospital records 
to confirm it was in fact lymphoma and what type of lymphoma.

I say this based on my own experience. I was told for years that my grandmother died 
of leukemia. I solicited her medical records and found that she in fact died of Non-
Hodgkin's lymphoma. So oftentimes family members may think they know the cause of 
death of a family member, but in fact may be mistaken. The only sure way to know is 
to ask for the medical records that you are in fact entitled to.


RadTravler: As mammographer, patients frequently ask about Estrogen and breast 
cancer. What are your thoughts on this?


Dr. David Johnson: Estrogen replacement therapy, especially when used for more than 
ten years does in fact cause a slight increase in the lifetime risk for acquiring 
breast cancer. However, this slight increase in risk was thought to be overruled by 
the benefit of estrogen in preventing heart disease. Recent studies, particularly the 
Women's Health Initiative, have seriously questioned the putative benefits of post-
menopausal estrogen in preventing heart disease, although the stated benefits in 
preventing osteoporosis still remain strong.

Therefore, choosing to use estrogen replacement therapy in post-menopausal women 
should be only after consulting with a knowledgeable gynecologist who's familiar 
with your particular family history and the latest research.


AnnieOakl: Dr., how do you solicit medical records? Do you need a lawyer or what? Do 
you have to know your relative's doctor or hospital? My family is hesitant to give 
out info and I suspect heart or alcohol related deaths.


Dr. David Johnson: Most hospitals require that the closest family member to the 
deceased give permission to release the records. This is usually adequate. If for 
some reason that family member refuses to give permission to release the medical 
records and you believe that could impact your health, the next step should be 
contact a lawyer, although this is very unlikely to be necessary.


Dearest: Dr. Johnson, do you have any closing comments you'd like to share with us. 


Dr. David Johnson: Dr. Sandmire and I wrote this book because we recognized the fact 
that so many serious diseases once confirmed by medical tests have a very poor 
outcome. The fact of the matter is these same tests used to diagnose the disease 
after symptoms are present would have detected the disease when the person was 
asymptomatic and would have had a much better outcome.

So we're not advocating everyone run out and have medical testing for various 
diseases while they're asymptomatic. What we are advocating is that you learn how 
to evaluate your personal risk for serious diseases and if you find that you are in 
fact at high risk, that you take advantage of the medical tests that can find these 
diseases prior to the appearance of symptoms when the chance of cure or good 
prognosis is much higher.


Dearest: Dr. Johnson, thank you for joining us in Power Surge tonight to share 
information about medical tests we need to protect our health. I strongly recommend 
Dr. Johnson's book, Medical Tests That Can Save Your Life: 21 Tests Your Doctor Won't
Order.... Unless You Ask. 



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