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A MUST READ!
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Medical mafia - A MUST READ!
Doctors are often
criticized for prescribing unneeded tests and procedures that harm more than
they help and add to medical costs that could otherwise be avoided. 12 medical
tests and procedures now being questioned worldwide as unnecessary and
potentially cause — sometimes harmful results to patients. Since a campaign was
launched last year, more than 130 tests and procedures have been called into
question by 25 medical specialty societies with more than 500,000 member
doctors. “Millions of Americans are increasingly realizing that when it comes
to health care, more is not necessarily better,” said Dr. Christine Cassel,Â
president of the ABIM Foundation. “Through these lists of tests and
procedures, we hope to encourage conversations between physicians and patients
about what care they truly need.”
United States
specialty societies representing more than 500,000 physicians developed lists
of Five Things Physicians and Patients Should Question in recognition
of the importance of physician and patient conversations to improve care and
eliminate unnecessary tests and procedures.
See the full list
12 MEDICAL TESTS
TO AVOID
1. Avoid Inducing Labor or C-Section Before 39 Weeks
Delivery prior to 39 weeks is associated with increased risk of learning
disabilities, respiratory problems and other potential risks. While sometimes
induction prior to 39 weeks is medically necessary, the recommendation is clear
that simply having a mature fetal lung test, in the absence of appropriate
clinical criteria, is not an indication for delivery. (American College of
Obstetricians and Gynecologists; American Academy of Family Physicians)
2. Avoid Routine
Annual Pap Tests
In average-risk women, routine annual Pap tests (cervical cytology
screenings) offer no advantage. (American College of Obstetricians
and Gynecologists)
3. Avoid CT Scans To
Evaluate Minor Head Injuries
Approximately 50
percent of children who visit hospital emergency departments with head injuries
are given a CT scan. CT scanning is associated with radiation exposure that may
escalate future cancer risk. CT technology exposes patients to approximately
100 times the radiation of a standard chest X-ray which itself increases the
risk of cancer. The recommendation calls for clinical observation prior to
making a decision about needing a CT. (American Academy of Pediatrics)
4. Avoid Stress Tests
Using Echocardiographic Images
The recommendation states that there is very little information on the
benefit of using stress echocardiography in asymptomatic individuals for the
purposes of cardiovascular risk assessment, as a stand-alone test or in
addition to conventional risk factors. (American Society of Echocardiography)
5. Avoid Prescribing
Type 2 Diabetes Medication To Achieve Tight Glycemic Control
The recommendation states that there is no evidence that using medicine
to tightly control blood sugar in older diabetics is beneficial. In fact, using
medications to strictly achieve low blood sugar levels is associated with
harms, including higher mortality rates. (American Geriatrics Society)
6. Avoid EEGs
(electroencephalography) on Patients With Recurrent Headaches.
Recurrent headache is the most common pain problem, affecting up to 20
percent of people. The recommendation states that EEG has no advantage over
clinical evaluation in diagnosing headache, does not improve outcomes, and
increases costs. (American Academy of Neurology)
7. Avoid Routinely
Treating Acid Reflux
Anti-reflux therapy, which is commonly prescribed in adults, has no
demonstrated effect in reducing the symptoms of gastroesophageal reflux disease
(GERD) in infants, and there is emerging evidence that it may in fact be
harmful in certain situations. (Society of Hospital Medicine)
ADDITIONAL MEDICAL TESTS
TO BE AVOIDED
8. Avoid Lipid Profile
Tests
Lipid Profile test checks various parameters of blood, such as
cholesterol (good or high density lipoprotein as well as bad or low density
lipoprotein) and triglyceride levels. Several scientific papers have proven
that people with high so-called “bad” LDL cholesterol live the
longest and there is noow a large number of findings that contradict the
lipid hypothesis that cholesterol has to be lowered at all.
9. Avoid Mammograms
Mammograms and breast screening have had no impact on breast cancer
deaths and have actually been found to increase breast cancer
mortality. With toxic radiation, mammogram testing compresses sensitive breast
tissue causing pain and possible tissue damage. To make matters worse, the
false negative and false positive rates of mammography are a troubling 30% and
89% respectively. Another concern is that many breast cancers occur below the
armpits; however, mammography completely misses this auxiliary region, viewing
only the breast tissue compressed between two plates of glass. Considering
these drawbacks, breast thermography should be given closer consideration.
Thermography is a non-invasive and non-toxic technique which can detect
abnormalities before the onset of a malignancy, and as early as ten years
before being recognized by mammography. This makes it much safer and
potentially life-saving health test for women who are unknowingly developing
abnormalities, as it can take several years for a cancerous tumor to develop
and be detected by a mammogram.
10. Avoid PSA Testing
A PSA blood test looks for prostate-specific antigen, a protein produced
by the prostate gland. High levels are supposedly associated with prostate cancer.
The problem is that the association isn’t always correct, and when it is, the
prostate cancer isn’t necessarily deadly. Nearly 20 percent of men will be
diagnosed with prostate cancer, which sounds scary, but only about 3 percent of
all men die from it. The PSA test usually leads to overdiagnosis — biopsies and
treatment in which the side effects are impotence and incontinence. Moreover,
there is some evidence which suggests that biopsies and treatment actually
aggravate prostate cancer. During a needle biopsy, a tumor may need to be
punctured several times to retrieve an amount of tissue that’s adequate enough
to be screened. It is believed that this repeated penetration may
spread cancer cells into the track formed by the needle, or by spilling cancerous
cells directly into the bloodstream or lympathic system.
11. Avoid Routine
Colorectal Cancer Screening
Colorectal cancer screening often results in unnecessary removal of
benign polyps which are of no threat to patients and the risks of their treatment
or removal far exceed any benefit. The evidence is insufficient to assess the
benefits and harms of computed tomographic colonography and fecal DNA testing
as screening modalities for colorectal cancer.
12. Avoid DEXA
Dual energy X-ray absorptiometry (DEXA or DXA) in a technique developed
in the 1980s that measures, among many things, bone mineral density. The scans
can determine bone strength and signs of osteopenia, a possible precursor to
osteoporosis. Limitations abound, though. Measurements vary from scan to scan
of the same person, as well as from machine to machine. DEXA doesn’t capture
the collagen-to-mineral ratio, which is more predictive of bone strength than
just mineral density. And higher bone mineral density doesn’t necessarily mean
stronger bones, for someone with more bone mass will have more minerals but
could have weaker bones.
Meanwhile, the ABIM
effort is gaining momentum and more financial support from key
players. The Robert Wood Johnson Foundationannounced it has awarded $2.5
million to “fund medical specialty societies and regional health improvement
collaboratives to work in specific communities to raise awareness of potential
overuse of medical care.”
“Reducing the
overuse of health care resources is a critical part of improving quality of
health care in America,” said Dr. Risa Lavizzo-Mourey, the Robert Wood Johnson
Foundation’s president and chief executive officer. “We want to see what can
happen when this work is targeted in specific geographic regions and are
pleased to help increase the tangible impact of the Choosing
Wisely campaign.
