May 3, 2012

BLESSED DEATH PANELS:

The testing glut: Finally, even medical specialty boards are moving against the overdiagnosis epidemic. (H. Gilbert Welch, May 2, 2012, LA Times)

Could American medicine be changing?

For years, medical organizations have been developing recommendations and guidelines focused on things doctors should do. The specialty societies have been focused on protecting the financial interests of their most profligate members and have been reluctant to acknowledge the problem of overuse. Maybe they are now owning up to the problem.

And judging from the content of the list, testing is a big part of that problem. Only a quarter of the recommendations fell in the category of "don't treat" -- as in, don't prescribe more chemotherapy for end-stage cancer that is beyond hope. The remainder fell in the category of "don't test."

Because it can be the first step in a cascade of medical interventions, the focus on testing makes good sense. The specialty boards seem to now recognize that the results of testing include both signals (useful information) and noise (false and distracting information). For patients with symptoms the signal predominates. But for those without symptoms the noise predominates. And the noise is not harmless, it can trigger overdiagnosis and overtreatment. "Routine" chestX-rays, for example, have a way of unearthing multiple abnormalities. This raises questions in physicians' minds -- triggering CT scans, needle biopsies, bronchoscopies and even surgery in an effort to answer them.

That's why multiple recommendations have argued against routine use of tests such as cardiograms (EKGs), ECHO and CT scans in asymptomatic patients -- and against repetitive testing in patients whose symptoms have not changed.

Admittedly, some of the recommendations seem brain-dead obvious.

Obviousness is no bar to hysteria.
Posted by at May 3, 2012 5:43 AM
  

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