4 Medical Tests You Should Possibly Avoid

Test…test… and more tests! We hear a lot these days about how our medical system is under-treating people. People who need medical care often can’t get it, they say. However according to a recent article in the Journal of the American Medical Association, over-treatment is probably a bigger problem.

The authors of the study clearly states. “Overuse of medical care, consisting primarily of over-diagnosis and over-treatment, is a common clinical problem.” Then they go on to describe how over-diagnosis and over-treatment is not only a waste of time and money, but can also result in needless harm and even death.

The first one is routine ultrasound screening of the carotid arteries. You can’t watch TV without seeing how smart it is for you to have an ultrasound screening of your carotid arteries. According to the ads, these screenings “save lives” and are “supported by 9 out of 10 cardiovascular doctors.” They go on to recommend that everyone over the age of 50 should get the screening every year because they say this will reduce your chance of a stroke.

The truth is that there is no documented benefit at all to this procedure. A systematic review and meta-analysis by the United States Preventive Services Task Force demonstrated that “no studies provided data on whether screening for carotid stenosis reduced stroke.” But that’s not all.

The same government task force went on to say that, this screening test leads to many more false positives than true positives.  That means that if you get one of these ultrasounds you are at risk… Risk of being encouraged to have a dangerous procedure that you don’t need and won’t benefit from.

That’s because, according to our authors, carotid angioplasty and stinting can result in death and stroke. And there are no studies that show that any of these procedures are any better than simple medical therapy.

According to the authors, carotid surgery to clean out the arteries does not reduce all-cause mortality, and its benefit compared to optimal medical therapy is not well-established.”

…of medical over-diagnosis and over-treatment is thyroid cancer. Years ago, published autopsy studies clearly showed that 100% of people over the age of 60 years have pathologically proven thyroid cancer. 100%! How many people over the age of 60 do you know that have died of thyroid cancer?  I don’t know of any.

“Thyroid cancer is massively over-diagnosed, leading to concrete harms.” This is a classic example of over-diagnosing and over-treating!

Routine thyroid cancer screening with ultrasound has been emphasized in South Korea for decades. And because of that, from 1993 to 2011 the diagnosis of thyroid cancer in South Korea increased 15-fold. The more often people had an ultrasound of their thyroid, the more often they were diagnosed with thyroid cancer.

What happened to these lucky people? “Virtually all patients diagnosed with thyroid cancer underwent surgery to cut out part or all of their thyroid, leaving most dependent on lifelong thyroid-replacement therapy. Approximately 11% of patients developed hypoparathyroidism and 2% vocal-cord paralysis after surgery.”

And the benefit?

“There was no change in thyroid cancer mortality.” Our authors conclude, “Over-diagnosis of thyroid cancer is extremely common. Harms associated with this over-treatment include lifelong thyroid replacement, hypoparathyroidism, and vocal-cord paralysis.”

Another useless procedure that women are encouraged to have every year is the dreaded pelvic exam. According to the data our authors uncovered, “Screening pelvic examinations are inaccurate in asymptomatic women (women without any symptoms) and are associated with harms which exceed clinical benefits.”

Routine annual pelvic examinations are one of the gold standards that all women are encouraged to go through every year whether they have a problem or not. But here’s what’s wrong with this approach.

There is no evidence to show that these pelvic exams have any benefit at all. The American College of Physicians recommends against routine pelvic exams for women without symptoms. Once again, there can be harm associated with routine pelvic examinations. “Harms of screening pelvic exams included: unnecessary procedures, including surgery (1.5% of women in one study); discomfort; anxiety; psychological harm; and embarrassment.” Their advice for doctors is good news for millions of women, “Do not perform screening pelvic exams. Clinicians should educate female patients about the low value of the exam.”

The last example of over treatment is CT scans of the head. According to the data, “Head CTs are ordered often, but rarely helpful.” There are two problems with unnecessary CTs of the head. One is, that they use a large amount of  X-rays. The other is that, “These scans can also reveal unimportant, incidental findings that lead to over-diagnosis and over-treatment.”

One study looked at 130 patients over the course of only one year.

During that time, they had an average of seven CT scans, including three CTs of the head! The authors point out that over 95% of these CTs were useless. “Only 4% of the head CTs had clinically significant findings that resulted in a change in management. Repeat head CT scans rarely impact patient management. Clinicians should be judicious in ordering multiple CT scans in the same patient.” If CTs are overused, how about tests in general?

Patients love tests. I once had a patient see me who brought in a two-inch-thick pile of test results. She had been to Mayo Clinic and was very pleased with what they had done. “They tested the heck out of me and found all kinds of abnormal results.” Then I asked, “So what did they do to help you?” Her response was, “Oh, they didn’t do anything. But they sure were complete.”

the reason patients saw doctors was to get help, not tests. Now all that has changed. In this age of ever increasing technology, we have more tests than ever. Many of them are ingenious. Many of them are expensive. Some of them are dangerous. And some of them are useful when properly applied. Our obsession with tests is so strong that the general implication is that a doctor just isn’t going to be able to treat a condition properly without a bunch of tests. And as the authors of this study point out, that’s just not true.

“Most diagnoses are based on history and physical exam.” The authors point out that a minimum of 73% and up to 94% of diagnoses can be correctly made simply from talking with the patient and performing a physical examination. This means in the overwhelming number of cases, no lab tests are needed at all.

75-80% of every case a doctor treats is going to get better no matter what he does as long as he doesn’t do something that is harmful to the patient. This means that 75-80% of the time a doctor treats a patient, the best treatment would be a placebo!

Over-diagnosis and over-treatment is especially dangerous when the treatments involve drugs, surgery, or other risky procedures. And it’s one more reason to establish a relationship with a doctor you can consult with who is versed in natural medical alternatives and who is not obsessed with tests.

Many of my patients have what they call their “regular doctor.” This is the doctor who is conventional in his approach, but who is also conservative about tests, drugs, and procedures. More often than not, their “regular doctor” is able to help them through the various health problems that might come up without exposing them to unnecessary tests and procedures. But when that doctor tells them that they need a treatment, test, or a procedure, they sometimes come to see me to get a second opinion. Often, I can save them from being one of the many cases of over-diagnosis and over-treatment that this recent article discusses.

Yours In Health,

Dr. Jack Belitz DC

PS  If you have a problem that you would like a second opinion or even a first opinion on, call 402-333-4848 and lets get together to find a solution.