More Medical Care May Prove Unhealthy
As reported by Lauran Neergaard, AP Medical Writer Back Pain No. 1 Most Overtreated Medical Issue (6/10)
More medical care won't necessarily make you healthier - it may make you sicker.
It's an idea that technology-loving Americans find hard to believe. Anywhere
from one-fifth to nearly one-third of the tests and treatments we get are
estimated to be unnecessary, and avoidable care is costly in more ways than the
bill: It may lead to dangerous side effects.
It can start during birth, as some of the nation's increasing C-sections are
triggered by controversial fetal monitors that signal a baby is in trouble when
really everything's fine. It extends to often futile intensive care at the end
of the life.
• Americans get the most medical radiation in the world, much of it from repeated
Too many scans increase the risk of cancer.
• Thousands who get stents for blocked heart arteries should have tried medication
• Doctors prescribe antibiotics tens of millions of times for viruses such as
colds that the drugs can't help.
• As major health groups warn of the limitations of prostate cancer screening,
even in middle age, one-third of men over 75 get routine PSA tests despite
guidelines that say most are too old to benefit. Millions of women at low risk
of cervical cancer get more frequent Pap smears than recommended; millions more
have been screened even after losing the cervix to a hysterectomy.
• Back pain stands out as the No. 1 overtreated condition, from repeated MRI scans
that can't pinpoint the trouble to spine surgery on people who could have
gotten better without it. About one in five who gets that first back operation
will wind up having another in the next decade.
Overtreatment means someone could have fared as well or better with a lesser
test or therapy, or maybe even none at all. Avoiding it is less about knowing
when to say no, than knowing when to say, "Wait, doc, I need more information!"
The Associated Press combed hundreds of pages of studies and quizzed dozens of
specialists to examine the nation's most overused practices. Medical groups are
starting to get the message. Efforts are under way to help doctors ratchet back
avoidable care and help patients take an unbiased look at the pros and cons of
different options before choosing one. "This is not, I repeat not, rationing,"
said Dr. Steven Weinberger of the American College of Physicians, which this
summer begins publishing recommendations on overused tests, starting with low
It's trying to strike a balance, to provide appropriate care rather than the
most care. Rare are patients who recognize they've crossed that line. "Yet let
me tell you, with additional tests and procedures comes significant harm," said
Dr. Bernard Rosof, who heads projects by the nonprofit National Quality Forum
and an American Medical Association panel to identify and decrease overuse.
"It's patient education that's going to be extremely important if we're going
to make this happen, so people begin to understand less is often better," he
Even Doctors' Families Not Immune
A hospital appropriately did six CT scans to check Dr. Steven Birnbaum's
22-year-old daughter for injury after she was hit by a car. But the next day,
Molly had an abdominal scan repeated as a precaution despite having no
symptoms. When a doctor ordered still another, "I blew a gasket," said the New
Hampshire radiologist, who put a stop to more.
Overtreatment extends into the maternity ward as well, where doctors can be too
quick to act on minor problems. There are numerous reasons that one of three
U.S. births now is by cesarean, but Dr. Alex Friedman blames some on an
imprecise monitor strapped to laboring women. Too often, he has sliced open a
mother's abdomen fearing the worst, only to pull out a pink, screaming bundle.
"Everyone knows it's a bad test," said Friedman of the Hospital of the
University of Pennsylvania. "You haven't done the patient a big service by
doing an unnecessary surgery."
Electronic fetal monitors record changes in the baby's heart rate, a possible
sign of too little oxygen. They became a tradition, now used in 85 percent of
births, years before research could prove how well they work. Guidelines issued
last summer, aiming to help doctors better interpret which tests are worrisome,
acknowledge the monitors haven't reduced deaths or cerebral palsy. But they do
increase the chances of a C-section. While they should be used in high-risk
women, the guidelines say the low-risk could fare as well if a nurse regularly
checked the baby's heart rate.
Later this year, the National Institutes of Health will begin a major study to
see if adding a newer technology, a type of fetal EKG already used in Europe,
to the heart-rate monitor would better identify which babies really are
struggling and need rapid delivery. Undertreatment was in the headlines over
the past year as the Obama administration and Congress wrestled with
legislation to get better care to millions who lack it.
The flip side, overtreatment, is a big contributor to runaway health care costs.
Yet it's one that lawmakers, wary of being accused of rationing, largely
avoided in the new health care law. Included were modest steps -- studies to
compare which treatments work best, some Medicare financial incentives to push
higher-quality, lower-cost care. "Physicians get up every day with the good
intentions of wanting to do what's best for their patients," said Dr. David
Goodman of the Dartmouth Institute for Health Policy. "We also live in
environments where there are strong financial incentives to deliver certain
types of care. We get well-paid for doing procedures. We get paid relatively
poorly for spending time with patients and helping them make choices."
Non-Invasive Health Scan Without Radiation