I was struck by the recurring themes in this week’s health news and planned to blog about it today. But Lindsey Tanner of AP beat me to it with her story, “Experts say US doctors overtesting, overtreating.”
“Too much cancer screening, too many heart tests, too many cesarean sections. A spate of recent reports suggest that too many Americans – maybe even President Barack Obama – are being overtreated.
Is it doctors practicing defensive medicine? Or are patients so accustomed to a culture of medical technology that they insist on extensive tests and treatments?
A combination of both is at work, but now new evidence and guidelines are recommending a step back and more thorough doctor-patient conversations about risks and benefits.”
I had picked up on that same theme in this week’s news:
• An independent panel convened this week by the National Institutes of Health confronted a troubling fact that pregnant women currently have limited access to clinicians and facilities able and willing to offer a trial of labor after previous cesarean delivery.
• A troublingly high number of U.S. patients who are given angiograms to check for heart disease turn out not to have a significant problem, according to the latest study to suggest Americans get an excess of medical tests.
• CT scans may pose cancer risk, new research indicates: Doctors, patients should weigh risks vs. rewards of medical imaging. (Chicago Tribune story.)
• Controversy over “value-based insurance design” that tries to address the problem of underuse of proven treatments and overuse of certain surgeries and diagnostic tests that may be less valuable. (Kaiser Health News story.)
• Expensive prostate cancer treatments are winning out over the old standards, driving up the cost of treatment before there’s clear evidence that they improve outcomes. (MedPageToday.com story.)
• Dr. Richard Ablin’s op-ed in the New York Times, “The Great Prostate Mistake.” Excerpt:
“Testing should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit.”
• And the letter to the editor that followed:
To the Editor:
I can only wish that Richard J. Ablin’s article had appeared years ago and spared me and probably many others needless pain and anxiety.
In 1997, at the urging of a couple of friends, I walked into a clinic feeling great and a bit foolish. P.S.A., 9-plus. Biopsy, of course (ouch), and I was told of a “little suspicious gray area” on a film. Lab test result, positive. Doctor recommendation: surgery or radiation.
I decided against both and never looked back, and have lived happily and healthfully ever after.
By the way, the 10 or 15 percent chance of bad side effects (I asked) from surgery is really far higher, from what I’ve read and heard. Watchful waiting is still the best suggestion any doctor can offer.
Robert S. Corya
Indianapolis, March 10, 2010
• CBS’ Harry Smith’s live colonoscopy coverage that never touched on any questions about evidence for colonoscopy and some of the questions that have been raised about the overselling of colonoscopy – perhaps resulting in the decline in use of a $20 blood stool slide test.
While Smith’s colonoscopy was being televised, I was attending a meeting entitled, “First, Do No Harm,” hosted by the US Agency for Healthcare Research & Quality. The purpose of the meeting was to guide future AHRQ research on how to get doctors and patients to stop pursuing approaches for which there is net harm – not benefit. Clearly, health care in the US struggles even with the clearcut issues of cutting back in the face of net harm – much less in grey areas where there is uncertainty about harms vs. benefits.
But kudos to Lindsey Tanner of AP for trying to tie together the week’s news in the way she did. We could have stories like that every week. And if we did, we’d have a lot smarter health care consumer population.