Interview with Prof. Christoph Bamberger on the subject of preventive healthcare

Our interview partner today is Professor Christoph Bamberger from Conradia Medical Prevention, one of the leading providers of preventive medical checkups in Germany. In the interview, Professor Bamberger explains to us his view of preventive healthcare and gives tips for a sustainably healthy life.

Dear Professor Bamberger, thank you very much for taking the time for this interview today. You are not only the founder and director of Medical Prevention in Hamburg, but also a nationally recognized internal medicine specialist and endocrinologist. Would you like to introduce yourself in your own words to the readers who do not yet know you?

In times of Corona, we have become concerned with our health or that of our loved ones on a daily basis. Nevertheless, many doctors are also reporting a decline in patients, especially with regard to preventive care. What is your impression of the current “health behavior” of Germans?

I can confirm this initial impression. In the first Corona phase, many people initially postponed non-essential examinations. Fortunately, however, this has now subsided. It was discovered that corona is something we have to live with for a longer period of time. Thus, we cannot adapt our entire life to it or align it to it. There are still other problems that are possibly, and in individual cases, even worse than corona. Early detection is very important in this context.

Although this early detection of serious diseases is so enormously important, many people completely ignore the topic of preventive health care for themselves. This starts with vaccinations and extends to other early detection measures. What do you think is the reason for this?

I think that in the foreground for many people is still the fear that something will actually be found. But that is, of course, an irrational train of thought. I like to compare it with the situation where you get on a vacation plane at the airport, but then you are told that it should not be examined, because otherwise something might be found. That is nonsense. Of course, the plane should be thoroughly inspected and repaired if there is a defect. Fortunately, however, preventive awareness has changed significantly among people in the last 15 years that we have been working here. More and more patients are taking a more rational approach. When we actually find something, they are among our most loyal patients. After all, we were usually able to save them in time.

With the “Prevention Index”, a project or index was recently presented by the University of Bielefeld, which is intended to show where Germany stands in terms of preventive health care. It is also intended to motivate politicians to become more involved in the area of prevention. Do you also think that more should be done for preventive healthcare at the political level in Germany?

I think more is done in Germany than most people assume. The screening programs we have introduced by law are already quite extensive, even compared with other countries. The programs start very early for women with regular gynecological examinations. Then there are dental examinations for both sexes and, from the mid-30s, laboratory tests. Later, prostate examinations, mammography and colonoscopy are added as very important preventive examinations. All of these offers need to be accepted by patients before saying that not enough is being done. I would be very happy to see that not just 50% of people take advantage of these preventative measure, but rather 90%. Nevertheless, in my opinion, the state should only interfere up to a certain point. Similar to the current Corona vaccination, I think there should only be a right to prevention, but no obligation to do so. Otherwise, people feel – rightly – that their freedom is being restricted. I think it would be better to create more incentives via the insurance companies, e.g. via a bonus program or premium reductions if someone actively takes care of their own preventive health care. In this respect, however, we are unfortunately still at the beginning.

But the people who actually do regularly take advantage of the preventive medical checkups offered by law seldom get a sense of security from them, or are not completely certain that they are “truly not sick”. For this, the statutory screening seems to be too little and perhaps not thorough enough. What is your opinion on this?

Yes, indeed, examinations are really lacking. I’ve only defended that people should take advantage of what is currently available. But of course, from my point of view and from what we are experiencing here, they are far from sufficient. A great deal is overlooked. Especially in laboratory tests, many important parameters are missing. For example, the thyroid gland is not examined, even though 10% of all people develop thyroid disease in the course of their lives. I also consider the PSA value, the prostate tumor marker, to be a very important value that is still not taken into account. Likewise, ultrasound exams are very useful, for example, to detect very early changes in the neck arteries. So yes, the programs could and really should be expanded.

How then does the health check-up at Conradia Medical Prevention differ from the compulsory health check-up from the age of 35?

There are actually several aspects where our program differs from the legally reimbursed preventive service. One is, of course, the time efficiency. With us, you get a holistic checkup in one day. This means you don’t have to make different doctor’s appointments, but can do everything “in one go”. The second very important aspect is the scope. We offer examinations that are not included in the compulsory preventive medical check-up, but which are very important for the early detection of certain diseases. This starts with an ultrasound program to examine the thyroid gland. Especially in women this organ is very often affected, thyroid diseases such as Hashimoto or thyroid nodules we find in 50% of our patients. Then the aforementioned neck arteries. We look at how the heart pumps and examine the abdominal organs including the liver, kidney and prostate. We also do another exercise ECG to get an idea of physical fitness and to get indications of any circulatory problems. We also do a pulmonary function test, a dermatologic exam and an ophthalmologic exam to detect early changes for age-related eye diseases that can lead to blindness. These include cataracts and glaucoma, but especially macular degeneration, for which it is necessary to examine the retina. This is an examination that is not performed by opticians. And as an even more special tool, we have whole-body magnetic resonance imaging, a radiation-free procedure in which we can image the entire body from head to toe in 45 minutes and rule out tumors as well as vascular changes or similar. This is particularly important because even the sonographic screening examinations performed by the general practitioner do not cover all organ systems, especially the head. However, we also want to see how the brain is, i.e., whether there are, for example, premature brain shrinkages that indicate a risk of dementia. Also, the organs in the chest are not commonly examined either. We can also include a breast MRI, which is much gentler than conventional mammography as a breast cancer screening without X-rays. The same is also available for the prostate, in order to be able to completely exclude prostate cancer by means of MRI. Above all, MRI is so costly that it will certainly not be covered by the state or the respective insurance company in the future. Individual responsibility is required here. In my opinion, everyone should ask themselves how much they are willing to pay for their health care and whether they can save on other aspects of their lifestyle to finance it. In the end, you either have the certainty of actually being completely healthy – and not just on the basis of a “pseudo check” – or you can be happy that an illness or a risk factor was discovered in time.

Yes, preventive health care can’t be prioritized highly enough. Do you notice a development in the diseases identified? For example, are there more people diagnosed with high blood pressure, obesity or cancer?

Cancers are already quite common. We detect a tumor requiring clarification in about every 100 patients. However, this can also be benign and the frequency has not changed in recent years. The average body weight goes up over the years, that is quite clear. As for the other diseases, we have a somewhat distorted picture here at the Prevention Center. Many of our patients have remained loyal to us since the beginnings of our practice and these are naturally getting older, which automatically leads to more diseases. Furthermore, many patients also come to us only when they already have unclear complaints that they would like to have examined.

Finally, the other way around: What does it take for a long-term healthy life? What are the pillars for long-lasting health?

Here in Hamburg, we have developed a four-pillar system which starts with preventative checkups. This will give us the knowledge and foundation on which we can personalize lifestyle adjustments on the second level. Of course, we all know the general rules of “don’t smoke, get plenty of exercise, eat healthy and keep your weight down,” but each body is not equally sensitive in the respective areas. For example, for one person two glasses of wine are already too much, while another person can drink almost a bottle a day. Although the latter is not recommended by doctors, it does not seem to have any direct health consequences for this particular person. In this way, the “Achilles’ heel” of each individual can be identified through screening.

The second stage is then lifestyle measures, for which we want to lay the foundation on the day of their visit. Many see the day here as a starting point or motivator to begin a healthier lifestyle, for example, to stop smoking or to exercise more. However, it is important to choose a lifestyle that is also enjoyable. Your aim is to form lifestyle habits that become automatic, much like brushing your teeth, for which you don’t need to chastise yourself. This is the best way to maintain a lifestyle change on the long run.

The third stage is taking certain preventive medications or sometimes hormones. A famous example of this is statins, cholesterol-lowering drugs for people with excessively high cholesterol levels, usually as a hereditary condition. These usually cannot be regulated by diet. And the fourth stage is what you would call psychological-mental wellbeing. This has an enormous part to play in healthy life expectancy. It is influenced by how socially integrated you are, whether you see meaning in life and have people who mean something to you. Having a job is also enormously important, especially in old age when your job is gone. As far as professional life is concerned, stress levels need to be kept in mind. Psychological-mental factors should not be underestimated. It is now said that one third of modifiable life expectancy is due to this component.

Professor Bamberger, thank you very much for the interview and the many interesting insights!