Medical Tests Can Be Hazardous to Your Health and Wealth

There are more than 7,500 parts in the human body; it sometimes seems there are drugs and tests for every one of them.

A recent article in The Washington Post identified 45 common tests that nine different medical groups have declared are either unnecessary or overdone, including colonoscopies. In addition to the 45 testing procedures, the seven most common of which will be identified momentarily, it is worth noting that spending on medicines in the U.S. grew in 2011 to $320 billion. (See Brian Vastag, Doctors Groups Call for End to Unnecessary Procedures, 04/04/2012.)

How does a nation of 313,303,160 (according to the U.S. Census Bureau) manage to function in such a drugged condition? It's a wonder anything gets done. (A cynic like Bill Maher, a comic like Andy Borowitz or even a wellness promoter like me might remark that this drug affliction, combined with excessive religiosity, helps explain how the Republican Party got the way it is at present.) One factor has to be that the pharmaceutical industry launched 34 new drugs last year, and spent billions promoting them.

But, enough about drug consumption - let me focus on the unnecessary testing issue. A National Academy of Sciences report estimated that 30 percent of U.S. health-care spending was inappropriate - a staggering waste of approximately $700 billion for procedures that do no good but can do harm.

At times like this, the media and others will ask, Who is to blame? It does not take genius to find fault with the key parties to this debacle, particularly patients and caregivers. However, both groups can justify somewhat why they act as they do. Patients are ill equipped to resist clever advertising; doctors are pressured to practice defensive medicine.

Better to focus on ways to remedy a dysfunctional situation.

In a report entitled Choosing Wisely released last week, the American Board of Internal Medicine Foundation unveiled a campaign to persuade doctors and patients to be more careful about 45 common test procedures. The Foundation did not recommend against any of the procedures, but asked for better decision- making about assessment tools that should be questioned. Joining the campaign are a dozen consumer groups.

What are the most suspicious procedures these groups want questioned more often? I'm summarize the top seven. To review all 45, see the Washington Post article referenced above.

1. Antibiotics for sinus infections - basically useless since the overwhelming majority of infections are not caused by bacteria

2. X-rays for low back pain. Such testing is appropriate only if clear indicators of a serious disease are present.

3. Stress tests done on healthy people who do not have diabetes or other indications of heart risks.

4. CT or MRI head scans as a response to an episode or two of fainting.

5. CT scans to detect appendicitis in children - less expensive ultrasound scans are as effective.

6. Colonoscopies! This is a biggie for me. I am a long-term resistor against the procedure. So far as I can tell, I'm at very low risk, so I'd rather await a non-invasive option for polyp detection that is simple and cheap. Such a DNA stool test awaits FDA approval. The Foundation, of course, is not so radical - it advises one colonoscopy per decade. (I stubbornly maintain that, for 85 to 90 percent of population, once every ten years is probably too often. What's more, a single colonoscopy might well be too many for most people.) In all other Western countries, only those at risk from other testing are offered colonoscopies through national health plans.

7. PET, CT bone scans to determine spread of early prostate and breast cancers. Low grade tumors that can be shown to be at little risk of metastasizing are not worth exposing the patient to unnecessary surgery, radiation and/or chemotherapy.

As promised, I favor not just less drugs and fewer medical test procedures but also more non-invasive wellness assessments. The latter would be designed to evaluate patient willingness to embrace appropriate levels of responsibility for their own lifestyle choices and actions.

I do recognize one problem with this approach, namely, that very few people are capable of doing much that is different from what they do now, given the limited ability any of us possess to will ourselves to change. Powerful memes of cultures and environments, traditions and circumstances, DNA and other genetic factors and more combine to constrain how we think and how we can act, even though most of us want to think we can choose to be different from the way we are.

For the moment, let's be more conservative about the tests we agree to undergo while considering new ways to remain well and become weller. After all, some folks may be able to change some of their ways, some of the time, with a little bit of luck and gentle guidance from doctors, wellness promoters, government, social policies and so on.

Publisher of the ARDELL WELLNESS REPORT (AWR) - a weekly electronic newsletter devoted to commentaries on current issues that affect personal and social well being from a quality of life perspective. The emphasis is on REAL wellness, which is also the topic of Don's latest book. Read about it here - - The "REAL" acronym reflects key issues embraced and advanced in Don's philosophy, namely, Reason, Exuberance, Athleticism and Liberty. Sample copy of Don's latest edition by request. If you like it, you can sign up - the price is right - free. Contact Don at

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