Healthcare - Interview

Interview with Jörg F. Debatin

Professor Debatin, the focus of your attention is early diagnosis and prevention. But do people really want to know about what's wrong with them?

Debatin: Most people do. It never ceases to amaze me how interested people are in learning about health issues. They want to know how they can stay healthy for as long as possible, and how illnesses can be identified and treated at the earliest possible stage. Imaging processes such as magnet resonance (MR) and computer tomography (CT) are not only useful for early diagnosis, but can also help a patient change the way he or she lives. Let me give you an example. An estimated two-thirds of all people with high blood pressure don't take their medication. The reason for this is that they feel fine and are lulled by a false sense of security. But then I show them the MR images of their head and say, "You see those little bright points in your head? Those are tiny little clots that have built up because you haven't been taking your medication." And this has a decisive effect on a patient's willingness to take active therapeutic measures.

Don't images of this sort also scare many people?

Debatin: No, not automatically. In my opinion, these kinds of images make an impression on people—and that's not the same thing as scaring them. Fear develops only if you leave people alone with a diagnosis. But what I do is offer them treatment and help them improve their quality of life in the future. When I show 45-year-old smokers the extent of the sclerosis in their main arteries, they tend to think twice about reaching for the next pack of cigarettes.

That sounds a lot like wagging a finger at a child. Don't many people find such an approach shocking?

Debatin: Yes they do. In fact, we actually call such an approach image shock therapy. And let me tell you, it is incredibly effective. Now, you might say to me that I take all the fun out of people's lives. I don't see it that way. The worst thing is that many people don't even know that they have a choice—either to live a short life full of fun and risk or to enjoy a long life with maybe a little less fun. I believe that people should definitely have the opportunity to decide for themselves which type of life they want to lead. I don't think there's anyone lying in a bed in this clinic who would claim to want to have a shorter life. v

In the U.S., people can have their whole bodies examined using computer tomography. Does this method really allow physicians to identify all illnesses?

Debatin: No. In the U.S., the whole-body CT is conducted without an intravenous contrast medium. I consider such examinations to be nothing more than medical nonsense because the diagnostic benefits are very small indeed. Without a contrast medium, radiologists can hardly identify damage in areas such as the head, kidneys and liver. Furthermore, the radiation levels are very high. What's worse is that it gives people a false sense of security. They think they've been given a clean bill of health because the doctors didn't identify anything suspicious in the images. However, neither blood nor urine are examined in this process.

Are you saying that the procedure is actually counterproductive?

Debatin: What is being offered in the U.S. at the moment is certainly not something that will establish itself on the market. Generally speaking, I don't consider it worthwhile to limit early diagnosis to the display of the entire body in images. As far as I'm concerned, a holistic approach should not only include magnetic resonance tomography, which involves no radiation and has no side effects, but also a general examination and a consultation with a physician, an exercise ECG and comprehensive laboratory analysis of blood and urine. We have developed just such a preventive program here in Essen. In April of this year, "Praeventicum" opened its doors in Essen to the general public for a comprehensive, early-diagnosis examination that includes a whole-body magnetic resonance tomograph.

At what age should people seriously consider having such a checkup?

Debatin: Those over 45 should certainly consider it, and those over 50 should definitely get a comprehensive check-up.

How much does such a checkup cost, and do health insurance companies reimburse for it?

Debatin: A Praeventicum customer pays approximately 1,500 € for the entire program. Because this is something that patients do voluntarily, the insurance companies are basically not obliged to refund anything.

Why? Aside from the obvious benefits, wouldn't such an examination cut health care costs?

Debatin: Most insured people assume that insurance companies have a vested interest in early diagnosis and preventive measures. That's not the case, however, because every approach that extends a person's life ends up costing the insurance companies even more money, since it means that people die at a later age and therefore suffer more illnesses.

The idea that prevention helps save money in the health care system is a fairy tale, at least in my view. For the economy, on the other hand, early diagnosis and prevention can be worthwhile because healthy employees don't call in sick very often. In addition, they continue working longer, thereby paying taxes and pension contributions for a longer period of time.

Are privately insured people in a better position than those in the public insurance system?

Debatin: I think people in Germany should get away from the mentality that insurance companies have to be involved when they want to do something for their health. Just compare this with car insurance. Vehicle owners have liability insurance, collision coverage, or third-party, fire and theft insurance (with or without a deductible). But who would ever think of taking out insurance for a car inspection? Automobile owners are not required to get their cars checked on a regular basis but, as we all know, it is wise to do so. I think that everyone should start taking more responsibility for their health. It's not about whether a person is privately or publicly insured—it's about whether they are willing to spend money on getting their own bodies checked, as is the case with car inspections.

Of course, not everyone has money for preventive care.

Debatin: That's where the politicians specializing in health care issues come in. They need to develop models for people in low- income brackets. One possibility would be to offer tax incentives for health check-ups. My hope is that Germans will realize in the coming years that they are responsible for their own health. Health insurance should only come into play when someone actually gets sick.

Interview by Ulrike Zechbauer

What does "Praeventicum" look for?