Annual EKGs to check cardiac function.
Imaging for low back pain.
Antibiotics for sinusitis.
Colorectal screening for cancer.
What do all these procedures have in common? According to the best available medical information, they are all overprescribed. The “Choosing Wisely” campaign by the American Board of Internal Medicine (ABIM) Foundation asked nine medical specialty societies (such as the American College of Physicians and the American Society of Clinical Oncology) each to create a list of “Five Things Physicians and Patients Should Question.” The 45 treatments that made the lists had costs—financial, physical, and even psychological—that, in most circumstances, outweighed the benefits.
This is the latest in a series of new studies showing that some routine medical procedures do not help, and may even harm, the average patient. The United States Preventive Services Task Force (USPSTF) recently recommended against the use of routine P.S.A. screening for prostate cancer. We don’t know yet how the doctors and patients will respond.
But there’s some evidence to suggest that they might not respond at all. A couple of years ago the USPSTF recommended that women at no particular increased risk have mammograms every two years (rather than every year) starting at age 50 (rather than 40). And still most women over 40 continue to expect an annual mammogram, doctors continue to prescribe them, and insurance companies and Medicare continue to pay for them. Why? The USPSTF makes extremely careful recommendations backed up by the latest, most respected studies. Shouldn’t day-to-day medical decisions be based on solid medical research?
I think so. But I read recently an interesting essay that argues that the culture of doctors encourages them to rely on their judgment more than the judgments published in academic journals—they don’t like to be second-guessed. And I know that most patients tend to want to do more, not less, when it comes to their health and the health of their family—even when “more” is, medically speaking, a mistake. Both these attitudes are understandable. But both need to change, so that doctors and patients make choices based on what makes sense from a medical point of view.
Health Care Perspectives 
This is very interesting – in addition to the above mentioned procedures, many doctors still recommend yearly Pap tests to screen for cervical cancer even though the guidelines suggest that some women can wait three years between negative tests. Overscreening for cervical cancer can result in unnecessary follow-up tests and procedures, which cause stress and pain for the women and increase costs to insurance companies.
Too many women I know have had one mammogram that is fine and one year later have stage 2 or 3 breast cancer- waiting two years could literally mean the difference between life and death and since many of my friends have died from breast cancer I think I would choose to err on the side of caution. Some of the recommendations are just to save money and I believe the bottom line is that a person’s life is worth more than a slight financial saving. My sister-in-law is a prime example- not a high risk patient, had a perfectly normal mammogram in 2010 and one year later had stage 2 breast cancer and had to have a double mastectomy. If she had waited an additional year to get her mammogram, as per the recommendation, the cancer may well have been too far advanced and she could have died. Personally, I will continue to get yearly mammograms and advise my daughters to do the same.
I appreciate your articles Dave, especially this one about doing less. I agree, many of these screenings are risky, costly and unnecessary for many individuals and it is important to look at the real need for them. Unfortunately as long as insurance companies have been mandated to pay for these screenings, there will be expectation that they are performed on nearly everyone. And there will be injuries, false positives and additional financial burden and strain to our health insurance and medical treatment systems. And people will suffer as a result.
While you have highlighted certain tests and treatments here, I see something missing. The most commonly pushed medical intervention on completely healthy, normal people is vaccines. We know these biological injections are not without risk and do in fact sicken, injure and permanently disable and kill a good number of people, mostly babies and little children. We are seeing increased incidence of whooping cough sweeping the nation and all evidence shows that those most heavily vaccinated with the pertussis vaccine are the ones most susceptible to this illness. Yet in the face of all evidence of harm, “public health officials” continue to push more and more injections of this vaccine. The pertussis vaccine is just one example of doing more harm than good with a vaccine. The chicken pox vaccine is another good example of a vaccine that has very short-term efficacy, must be repeated over and over and over again throughout the lifetime in an attempt to keep a mild childhood illness at bay. But the fallout of this has been tragic. There now exists a new strain of chicken pox caused by the vaccine and even more serious and costly is an epidemic of shingles sweeping the nation, the result of vaccination against chicken pox. For the first time, we are now seeing young adults and children with shingles. I’m sure you know that in comparing chicken pox and shingles there really is no comparison. Chicken pox is quite mild for nearly everyone and most easily recover with life-long immunity. Shingles on the other hand is a very serious illness with significant complications likely and significant pain, suffering, hospital expense and loss of work. The CDC has known of this problem with the chicken pox vaccine and shingles since completing their VASP study in 2003. The shingles vaccine is a poor and risky antidote for the chicken pox vaccine fallout. Yet we allow these public health officials to continue to push and demand more and more injections, causing much suffering and increased insurance and medical treatment costs.
I hope that you will consider the hazards of indiscriminate mass vaccinations to be a worthy topic of investigation and reporting. Thanks.