In case you missed it, a recommendation came out last month that physicians cut back on using 45 common tests and treatments. In addition, patients were advised to question doctors who recommend such things as antibiotics for mild sinusitis, CT scans for an uncomplicated headache or a repeat colonoscopy within 10 years of a normal exam.
The general idea wasn’t all that new — my colleagues and I have been questioning many of the same tests and treatments for years. What was different this time was the source of the recommendations. They came from the heart of the medical profession: the medical specialty boards and societies representing cardiologists, radiologists, gastroenterologists and other doctors. In other words, they came from the very groups that stand to benefit from doing more, not less.
Nine specialty societies contributed five recommendations each to the list (others are expected to contribute in the future). The recommendations each started with the word “don’t” — as in “don’t perform,” “don’t order,” “don’t recommend.”
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.
Dear Mrs. Smith, I am writing to inform you that we exposed your body to an unnecessary level of radiation during your visit to our hospital. Oh, by the way, that was two years ago. We don’t intend to do anything about this for you. Also, we have known about this problem for a long time, and we don’t expect to change our procedures for future patients. Just wanted you to know. Yours in delivering the best health care in the world, Chief of Radiology and CEO. (Jointly signed.)
That’s the essence of this article by Walt Bogdanich and Jo Craven McGinty in the New York Times. Here are excerpts:
Long after questions were first raised about the overuse of powerful CT scans, hundreds of hospitals across the country needlessly exposed patients to radiation by scanning their chests twice on the same day, according to federal records and interviews with researchers.
Double scans expose patients to extra radiation while heaping millions of dollars in extra costs on an already overburdened Medicare program. A single CT scan of the chest is equal to about 350 standard chest X-rays, so two scans are twice that amount.
There’s an eerie video up on YouTube, shot by a Japanese journalist who ventured into the evacuation zone surrounding the Fukushima nuclear power plant, armed with a camera and a radiation meter. The video looks like b-roll footage from a low-budget zombie movie, with roving bands of stray dogs and a soundtrack of the radiation meter’s increasingly frantic beeping.
Shortly after the earthquake that damaged the plant, the Japanese government evacuated residents from a more than 1,000 square mile zone. Last week, they raised the severity level of the crisis at Fukushima to a 7 out of 7, making it the worst nuclear disaster since the complete meltdown of the reactor at Chernobyl, in 1986. In its wake, worldwide fear of nuclear power spiked. The German government shut down seven of its 17 nuclear reactors, and plans to eliminate nuclear power by 2020. In the U.S., a Fox News Poll conducted in early April found that 83 percent of respondents thought a similar disaster could happen to an American nuclear plant.
People fear radiation for good reason. All ionizing radiation passes unimpeded through cells of the body, mutating or destroying DNA along the way. The danger level depends on the dose and the length of exposure. We’re exposed to small amounts of radiation all the time — from cosmic rays to the normal radioactive decay of soil, rocks and building materials. Even the granite in the U.S. Capitol Building emits low levels of radiation. These levels are harmless, but a high dose can kill, and prolonged or repeated moderate exposure can lead to cancer.Continue reading…