How Can We Curb the Medical-Testing Epidemic?

[FarCenter]

We are facing an epidemic in this country, a threat to our health caused not by pathogens, environmental toxins or lousy diets but by medical tests. Over the past couple of years, we’ve learned that two popular tests for cancer—mammograms and the PSA (prostate-specific antigen) test for prostate cancer—are less than useless for many people. Men are 47 times more likely to get unnecessary, harmful treatments—biopsies, surgery, radiation, chemotherapy—as a result of receiving a positive PSA test than they are to have their lives extended, according to a major European study. The ratio for women undergoing mammograms is between 6 and 33 to one, according to a new analysis by researchers at Dartmouth.


Now Gina Kolata, who has been diligently tracking debates over medical testing for The New York Times​, reports on a recent study in which 31 professional baseball pitchers were scanned with magnetic resonance imaging. The study revealed that 28 of the pitchers had abnormal shoulder cartilage and 27 had abnormal rotator cuff tendons. Here’s the problem: all of the pitchers were perfectly healthy, throwing without any pain. This and other studies, Kolata asserts, show that MRI scans “are easily misinterpreted and can result in misdiagnoses leading to unnecessary or even harmful treatments.” I suspect that critical evaluations of many other medical tests would yield similar conclusions.

...
Cancer screening in particular is “vastly overused in the United States, with about 40 percent of Medicare spending on common preventive screenings regarded as medically unnecessary,” according to an investigation by the Center for Public Integrity. “Millions of Americans get such tests more frequently than medically recommended or at times when they cannot gain any proven medical benefit, extracting an enormous financial toll on the nation’s health care system.” PSA testing alone costs about $3 billion a year, according to the test’s developer, Richard Ablin, an immunologist at the University of Arizona. He calls PSA screening a “profit-driven public health disaster.”

http://blogs.scientificamerican.com/cross-check/2011/11/07/how-can-we-curb-the-medical-testing-epidemic

[Big Blue Marble]

1. This is a least partially due to profit-based medicine.

It is also because the technology is there and doctors depend more and more these tests for definitive
diagnosis. The patients due not often have the expertise to determine how necessary the tests actually are.

Yet we the patients are the ones paying for all of it. The system is totally broken.

[FarCenter]

3. Part of the problem is that patients do not pay for the tests

As the article points out, the patient in the example only paid a comparatively small co-pay.

Furthermore, the doctors and testing labs get paid more if they test more, so they have an incentive to order more tests.

The insurance companies and Medicare are the only organizations pushing back on more testing.

If the patients were paying a larger share out of pocket, they would probably be more diligent about researching whether the tests were necessary.

However, with the system as it is, the better solution is to come up with better guidelines for doctors and labs regarding what the costs and risks of the procedures are.

For example, with the PSA tests, an elevated PSA reading usually causes the doctor to order up a biopsy. This is done by entering the patient's rectum and inserting needles into the prostate via the wall of the rectum. As you might expect, the complications from infections are quite high, running 4 to 7%.

So even setting cost aside, what are the tradeoffs of risking infection and complications of a biopsy now versus simply monitoring PSA and the prostate for some months, given that most prostate cancers are very slow growing.

Two close acquaintances have had biopsies with negative results, and luckily no complications. But it is not a comfortable procedure.

[Big Blue Marble]

16. The medical system is quickly pricing itself out of existence.

Fewer and fewer can afford either the insurance or the co-pays. Let alone those who do not have insurance to help.
If something does not change soon, this country will bankrupt itself through its medical system. This is not a sustainable
way to care for sick people.

[Dennis Donovan]

2. "test(s) are less than useless..."

As someone who has had loved ones saved by such tests, I call bullshit on the article.:thumbsdown:

[pitohui]

9. it is clearly a politically motivated thing to screw us for the price of tests

read the post above, claiming the problem is caused by "patients don't pay for the tests"

pretty to see where this "message" is coming from

[Sgent]

4. See the

controversy over the changes in PAP, Breast Cancer, and Prostate Cancer screening guidelines.

In many/most cases, the only two groups supporting over-testing are patients and specialists (example urologists who make a lot of money from unnecessary followup). The academics, community docs, and everyone else know that they are a waste of time, money, good health, etc.

Then of course you have republican's accusing them of death panels and the like...

Finally, malpractice risk is based on community standards, not best practices. So a physician who doesn't order unnecessary testing leaves themselves open to the risk of non-diagnosis of an issue -- regardless of the fact its good medicine.

For instance, ASYMPTOMATIC PSA screening saves about as many lives as it costs (due to complications from biopsy, etc.), in addition it costs billions for screening and followup costs, plus leaves thousands impotent, with colostomy bags, etc. But if someone sues they very well may win a failure to dx.

[cbayer]

5. K & R

[Horse with no Name]

6. My opinion is that there are very few entitities out there that really care

about people over profits.

I trust very few of them because they are run by people who are partisan.

I think that the insurance companies are tired of paying for these annual tests and now they have members of the medical/scientific communities out there selling the notion that they are unnecessary.

Ask the millions whose lives have been saved by these unnecessary tests and I am sure that they will tell a different story.

[emilyg]

7. It was a mammo that detected early

stage breast cancer in me. Now it was blood tests and colonoscopy that detected colon cancer in me.

[ThomWV]

8. Next monday I will have a tennis-ball sized tumor removed from my gut because of tests.

I will probably be posting here for the last time for a while on sunday evening from a room my wife and I will be staying at near the hospital. The tumor was missed by the first tests I went through, but now its large enough to be seen easily by most methods they use. The thing may kill me, removing the thing may kill me, but testing to find it sure didn't do anything to kill me. So I really don't have much sympathy for your point to tell the truth.

[Horse with no Name]

10. Please keep us posted Thom

and if your wife would in your absence, we would be honored.

Will be sending special thoughts to you and your surgical team for a successful outcome. :hug:

[ThomWV]

11. Thank you. If you do not hear from me within a week from next monday you may assume the worst.

The first surgeon who was going to do the cutting rather bleakly told me that my chances of surviving the operation were about 50/50. We found another surgeon who I am told is probably the best in the world for dealing with the thing I have. He says it will be OK. I trust him but just to be sure I updated my will today. The operation is monday morning, I am told I will be hospitalized for at least a week afterward. So if you don't hear from me by a week from monday you may safely assume that things did not go well.

[Horse with no Name]

13. ......

You can't go.

Will tuck you safely in my thoughts. Take care of you.:hug:

[Capitalocracy]

12. I wish you the best of luck

And I'm sorry you have to go through that.

[Capitalocracy]

14. This is from The Onion, right?

Wow. Cancer screenings are anything but unnecessary.

[Horse with no Name]

15. They are dipping into profits

so...they must go.

Had a long fight on a thread a year or two ago about doing away with Pap smears (yeah, some think they are unnecessary!)