On Tuesday evening, June 25, the Navigating the Medical System Lecture Series featured Dr. Melvin J. Breite, MD, of Internal Medicine at NewYork-Presbyterian Queens, for the final virtual lecture of the year, hosted by Congregation Etz Chaim.
Dr. Breite, Founder and Director of the Lecture Series, shared practical information and updates from the medical field, including recent research and important policy changes.
He noted several key updates regarding insurance coverage. Medicare has revised its policies to cut costs, and as a result, certain routine tests that were once part of an annual physical are no longer covered, such as routine EKGs, cholesterol tests, and chest x-rays. These tests must now be medically justified in advance, or patients may be billed.
Insurance companies are increasingly requiring prior authorization for imaging and some medications. In some cases, when you receive a prescription, it’s important to ask about the co-pay and request a similar alternative if needed. Insurers are also strict about timing; for example, A1C tests must be spaced at least 90 days apart. Dr. Breite shared that one of his tests was rejected because it was submitted after only 89 days.
Vaccination guidelines are also in flux. As government recommendations change, so will insurance coverage.
Dr. Breite emphasized that most doctors get their information from peer-reviewed medical journals. The most prestigious among them is the New England Journal of Medicine. Articles are reviewed by a committee of peers, and if rejected, are often submitted to less reputable journals. He cautioned that there are “predator” journals that publish low-quality research for a fee, so it’s important to be aware of where your doctor gets information. He added that government officials have accused large pharmaceutical and medical device companies of influencing research in favor of their products.
Dr. Breite stressed that your primary care provider should be the central figure in managing your health. Specialists such as surgeons or orthopedists must send records back to your primary care provider to ensure continuity of care.
He encouraged regular dental check-ups, annual eye exams, annual mammograms for women, and colon screenings as recommended. He also advised patients to bring their medications with them to every doctor visit.
Turning to diet – a topic he has emphasized throughout the years – Dr. Breite referenced a recent study published in Nature Medicine by Harvard and other universities. It followed 30,000 people over several years and concluded that a healthful diet leads to better quality of life as people age. A diet rich in fruits, vegetables, fish, and healthy fats – and low in trans fats, sugar, processed meat, red meat, and salt – is recommended. “It all begins in the supermarket,” he remarked.
Dr. Breite also spoke about vaccines. The newest pneumonia vaccine is recommended for anyone over 50 and is generally well-tolerated. The updated Covid vaccine is more complex, as the virus changes annually and the vaccine may cause side effects. He cautioned against the RSV vaccine unless one has chronic lung disease. He strongly recommended the shingles vaccine, which is 99% effective and available at local pharmacies.
Next, he discussed GLP-1 medications. Research suggests that they may reduce asthma and arthritis knee pain, but they can also lead to rare eye conditions, so patients should monitor their vision. These medications also interfere with colonoscopy preparation, and most GI doctors recommend stopping them a few days prior to a procedure. Additionally, once patients stop taking GLP-1 medications, they often regain the weight lost during treatment.
Dr. Breite urged caution regarding excessive CAT scans. Patients should ask their doctor about alternatives, such as MRIs, or try to space out imaging over time.
For women with frequent urinary tract infections, he advised asking their doctor to check for uterine prolapse, which can often be treated with a device. For men, prostate health should be evaluated.
He then turned to the topic of blood pressure. Proper treatment helps prevent strokes and heart attacks. A normal reading is 130/60. Patients should use a reliable home monitor, avoid taking readings over clothing or shortly after consuming coffee or tea, and check their blood pressure in both the morning and evening. Keep a daily record for one week to share with your doctor.
To prevent high blood pressure, maintain a healthy weight, avoid excess salt, and manage diabetes.
Regarding cholesterol, Dr. Breite stated that a normal level is 100. If your LDL cholesterol is 150 or higher, statins are advised to prevent strokes and heart attacks. Side effects may include muscle aches and hair loss.
For seasonal allergies, he recommended nasal sprays with antihistamines over steroid inhalers—and both over oral antihistamines.
He also suggested doing a runner’s stretch before bedtime to help prevent leg cramps.
He cited a study showing that the drug metformin is safe for men hoping to become fathers.
The community expresses its appreciation to Dr. Breite and Congregation Etz Chaim for providing such informative – and often life-saving – lectures.
By Susie Garber
