I previously discussed that what is “normal” for one group of people may not be the same for another—especially when comparing non-vegetarians and vegans. For example, prescribing medication or supplements to a vegan simply because a blood parameter falls outside the normal range can be misguided. It’s essential to consider other factors in such cases.
Similarly, advising people to undergo numerous tests without cause is not prudent. Tests should be conducted only when there is reason to suspect something may be wrong and when a patient has reported symptoms.
This issue has been debated in the United States for some time. As a result of this debate a foundation was created by the American Board of Internal Medicine (ABIM) with the primary purpose of improving public health. The mission statement on their website is:
“To advance the core values of medical professionalism as a force to improve the quality of health care.”
Programs supporting this work include the
*Choosing Wisely® campaign,
*“Teaching Value and Choosing Wisely Challenge”,
* “Putting Stewardship into Medical Education and Training” grant program.
Of these, “Choosing Wisely” is of special interest to us. The goal of this campaign is to promote conversations between clinicians and patients by helping patients choose care that is:
* Supported by evidence
* Not duplicative of other tests or procedures already received
* Free from harm
* Truly necessary
It calls upon leading medical specialty societies and other organizations to identify tests or procedures commonly used in their field whose necessity should be questioned and discussed with patients. 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.
Since the campaign was launched in 2012, more than 400 tests and procedures have been called into question by 70 medical specialty societies with more than half a million member doctors. “Millions of Americans are increasingly realizing that when it comes to health care, more is not necessarily better,” said Dr. Christine Cassel, 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.”
Twelve medical tests and procedures are now being questioned worldwide as unnecessary and potentially cause some harmful results to patients are listed below.
12 Medical Tests to Avoid
1. Avoid Inducing Labor or having a C-Section Before 39 Weeks:
Deliveries before 39 weeks are associated with increased risks of learning disabilities, respiratory issues, and other complications. While early delivery is sometimes necessary, the recommendation is clear: a mature fetal lung test alone, without other medical reasons, is not enough to justify delivery before 39 weeks.
(American College of Obstetricians and Gynecologist; American Academy of Family Physicians)
2. Avoid Routine Annual Pap Tests:
For women at average risk, annual Pap tests (cervical cytology screenings) do not offer added benefits over less frequent screening. (American College of Obstetricians and Gynecologists)
3. Avoid CT Scans To Evaluate Minor Head Injuries:
About half of children who visit emergency departments for head injuries receive a CT scan, exposing them to radiation that can increase future cancer risk. These scans involve radiation levels approximately 100 times that of a standard chest X-ray. Observation should precede any decision about CT scanning. (American Academy of Pediatrics)
4. Avoid Stress Tests Using Echocardiographic Images:
For asymptomatic individuals, stress echocardiography adds limited value in assessing cardiovascular risk and may not justify its use. (American Society of Echocardiography)
5. Avoid Prescribing Type 2 Diabetes Medication To Achieve Tight Glycemic Control:
For older adults with Type 2 diabetes, there is no evidence that strict blood sugar control improves health outcomes. In fact, it may lead to higher mortality rates. (American Geriatrics Society)
6. Avoid EEGs (electroencephalography) on Patients With Recurrent Headaches:
Recurrent headaches affect up to 20% of people. However, EEGs provide no diagnostic advantage over a clinical evaluation, do not improve treatment outcomes, and add unnecessary costs. (American Academy of Neurology)
7. Avoid Routinely Treating Acid Reflux:
Anti-reflux medications, while common for adults with GERD, are not effective for reducing symptoms in infants and may even cause harm in certain cases. (Society of Hospital Medicine)
8. Avoid Lipid Profile Tests:
The lipid profile test checks cholesterol and triglyceride levels.
Several scientific papers have proven that people with high so-called “bad” LDL cholesterol live the longest and there is now 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 ons no et 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 Dual Energy X-Ray Absorptiometry (DEXA or DXA):
This 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.
The ABIM initiative to reduce unnecessary testing is commendable, though it has received limited media coverage. Ideally, information on these recommendations would be displayed in clinic waiting rooms for patients to see.
I encourage everyone to understand these recommendations and make informed decisions. While these tests may still be needed in certain situations, it is wise to discuss your options with your doctor or consider a second opinion before proceeding.
Disclaimer
Views expressed above are the author’s own.
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