There is increasing interest in the over use of medical tests, medications and procedures. There has been a belief that more medicine equals better health. In reality it does not. Whilst we absolutely can and do benefit from the advances medicine has made, too much of a good thing is a problem.
At a conference recently, some interesting figures were presented. Australia with a population of around 24 million has 7.4 million tests of Thyroid function done each year. Whilst this is not the same as 7.4 million separate people having tests, it is still a massive amount. Much of this is “screening”. But as we know screening can throw up test results, which whilst outside the reference range, do not mean the person has a problem. Every test will have a least 5% of people with a false “positive” as the normal ranges are defined statistically to include only 95% of “normal” cases.
Doppler (a form of ultrasound) tests on neck arteries would over diagnose problems in 90% of people. In other words, if the test was reported as “abnormal” there was only a 10% likelihood that you actually had a problem requiring treatment.
In March papers in the Lancet claimed that in Australia we (largely the taxpayers) spent $4.8 billion each year on treatments for low back pain, which either did harm or did not help. This included surgery, imaging and use of opiate medications. Meanwhile, yoga, described by the authors an evidence based received no government subsidy.
I recently read the book “Surgery – the ultimate Placebo” by Professor Ian Harris where the benefit of various surgical procedures is questioned. In particular the author correctly observes that surgical procedures are adopted without the trials that are standard in pharmaceuticals. He does not claim that surgery does not work but that people improve less because of the procedure and more because they have had it done (placebo effect) or because they would have improved anyway.
There have been trials where “sham” surgery (the patient is put to sleep an incision made) is compared to actual surgery in knee and shoulder arthroscopic surgery. The results show no better results after actual surgery. Use of drug eluding stents in heart disease, have also been shown to be relatively expensive placebos.
Over diagnosis where people are diagnosed with a disease or problem when they don’t actually have one is a growing problem. This is a big problem with screening programs that detect small growths that would never cause any problem for the individual. Yet because they are found they are treated.
The relentless lowering of thresholds for cholesterol, and blood pressure (where there is a renewed push to lower thresholds for treatment) together with the widening of definitions for mental health conditions in the DSM5 reclassifies ever more healthy people into patients needing treatment. Given much of this treatment is long term then that is a good business model. However, these treatments have costs and more importantly potential harms and side effects. There may be little if any benefit to the individual.
Individuals need to be questioning of doctors about the need for tests and treatments and of public health edicts about screening. More medicine does not equal better health.
Dr Joe Kosterich is a Medical Doctor, author, speaker, media presenter and health industry consultant, who wants you to be healthy and get the most out of life.
Joe writes for numerous medical and mainstream publications and is also a regular on radio and television. He is often called to give opinions in medico legal cases and is an advisor to Reed Medical Conferences.
Joe is Medical Advisor to Medicinal Cannabis Company Little Green Pharma and sits on the board of Australian Tobacco Harm Reduction Association.