I never guess right. I opted for an extended warranty on a TV that I purchased just after the Civil War. The thing has never broken down. I purchased a clock that came with a one-year warranty. It stopped working at the tick of one year and one minute.

It all seems pretty shady to me. Auto warranties are the worst. New cars come with five to ten year warranties and you are told you have only to bring it in for a checkup every 50,000-100,000 miles. Detroit is smoking some illegal plants if they think the public will fall for that nonsense.

In contrast to the fantasy programs of automakers, the public knows that most cars are in need of some care at 10,000 miles, are frequently in intensive care units at 50,000 miles, and begging for mercy at 100,000 miles. I will never figure out the correct timing for routine auto care or the most reasonably warranty program for any of this stuff.

But what about routine checkups for you? What is routine maintenance for the human body?

In 1992, the American Medical Association proposed comprehensive annual physical examinations for all adults that included a battery of diagnostic tests. Sixty years later the American College of Physicians recommended that the annual physical examination be abandoned in favor of a more selective approach designed to find the common diseases early (i.e., high blood pressure, cancer), or prevent them completely (i.e., immunization programs).

In 1984, Uncle Sam became involved and established the United States Preventive Services Task Force (USPSTF) that is responsible for developing the list and timing of tests Americans should have carried out in order to protect their health. The current USPSTF recommendations, published in 1996, for adult periodic health examinations, are as follows:

SCREENING TEST/FREQUENCY

• Blood pressure/At least every 2 years
• Breast Examination/Annually after age 40
• Mammography/Annually after age 50
• Pap smear/Every 2-3 years
• Stool for occult blood/annually after age 50
• Flexible sigmoidoscopy/Every 3-5 years after age 50
• Cholesterol/Every 5 years
• Hearing-Vision/Periodically
• Tetanus-diphtheria booster/Every 10-15 years
• Influenza vaccine/Annually after age 65
• Pneumoccoccal vaccine/One time after age 65
• Talk to a health professional/Annually

This table should be taped to the inside of the medicine cabinet today. It will serve as a reminder of the big picture of your health as you look in the mirror.

Untreated hypertension causes heart, brain and kidney disease. Breast, uterine, cervix and colon cancer are common and can be cured if detected early.

When you reach for the aspirin for the 20th time for that headache, you might get your blood pressure checked. When you take that herbal laxative, it may occur to you to be checked for colon cancer.

This list does not have many tests you might have expected. Chest x-ray for lung cancer and prostate specific antigen (PSA) blood test for prostate cancer are not listed. That is because it has not been clearly demonstrated that annual chest x-rays identify lung cancers at an earlier, curable stage. Similarly, the PSA test is not specific for cancer and it has not been demonstrated that screening for prostate cancer improves survival.

The USPSTF lists tests which will change outcomes of diseases if found early. The American Cancer Society (ACS) recommends annual PSA testing because it’s goal is to find as many cancers as possible whether or not the outcomes or management will change. Similarly, the USPSTF and the ACS make recommendations without specific reference to cost-effectiveness analysis – how many dollars spent per life saved or years of good health gained. You can bet that your insurance company or HMO considers these matters in making its policy recommendations.

We wince at the thought, but we are more likely to make our decisions regarding VCR warranties and routine auto checkups about the same way the HMO does. Do I spend the money, do all preventive work, or hope it all works out fine since it usually does?

Try looking at it this way: Being 50 years old is like having a car with 50,000 miles. Don’t plan any long trips or make long-range plans without a checkup.