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Experts Say U.S. Doctors Overtesting, Overtreating

April 01, 2010 | 41,083 views
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overtesting, unwarranted medical treatmentsToo much cancer screening, too many heart tests, too many cesarean sections. A spate of recent reports suggests that many Americans are being overtreated.

New evidence and updated guidelines are recommending a step back and more thorough doctor-patient talks about risks and benefits of screening tests.

Just recently, a New England Journal of Medicine study suggested that too many patients are getting angiograms -- invasive imaging tests for heart disease -- who don't really need them.

Specialists convened by the National Institutes of Health said doctors are too often demanding repeat cesarean deliveries for pregnant women after a first C-section.

The American Cancer Society cast more doubt on routine PSA tests for prostate cancer not long ago. Other groups recommended against routine mammograms for women in their 40s, and for fewer Pap tests looking for cervical cancer.

 

Dr. Mercola's Comments:

I’ve written about nearly all of the tests mentioned in this Seattle Times article. You can access all those previous articles by using the search engine on my site. Now, if you didn’t already know this, American medical care is the most expensive in the world, and unnecessary or dangerous tests and unwarranted treatments are a part of this problem.

The U.S. spends more than twice as much on each person for health care as most other industrialized countries. And yet it has fallen to last place among those countries in preventing avoidable deaths through use of timely and effective medical care, which is why I’m pleased to see that conventional medicine is finally beginning to take a closer look at whether or not all this testing is helping or harming patients in the long run.

There are too many to go through them all in this article, but let’s review a couple of the most overused medical tests and treatments that may do more harm than good, and what your options are.

Cesarian Section – One of the Most Over-Utilized Surgeries in the US

According to the National Center for Health Statistics, more than 31 percent of the 4.3 million births in 2006 were surgical, at a price tag of anywhere between $2,000 and $200,000 each. Planned cesarean births cost an average 76 percent more than a vaginal birth, according to a 2007 report published in the journal Obstetrics & Gynecology.

So who really benefits from these surgical interventions?

Mainly doctors and hospitals, and pharmaceutical companies, of course. They are, opposed to popular opinion, NOT in the best interest of the mother and child.

Granted, there are times when a cesarean section can save lives, such as in the event of a prolapsed umbilical cord (the umbilical cord slips through the cervix before the baby and may endanger the baby’s oxygen supply) or placenta previa, which occurs when the placenta grows in such a way that it blocks the baby’s exit through the cervix.

Other situations, including when the baby is in a transverse (sideways) position or if the mother is having an outbreak of genital herpes, may also call for a cesarean section.

But according to the World Health Organization, there’s no justification for having a cesarean rate of more than 10-15 percent, and the US is clearly in non-justified territory.

There are several reasons for this, but one of the factors is the presumption that C-sections are safe. However, it’s a major surgery, and many are simply unaware of the risks involved.

C-Section Comes with SIGNIFICANT Health Risks to Mother and Baby

Consider these facts, for example: One study in the British Medical Journal found that a woman’s risk of death during delivery is three to five times higher during cesarean than a natural delivery, her risk of hysterectomy four times higher, and her risk of being admitted to intensive care is twice as high.

These are significant risks – especially when the surgery is medically unwarranted!

In addition, women who undergo cesareans are at an increased risk of many other complications compared with a natural birth as well, including:

  • Infection to various organs including the uterus, bladder or kidneys
  • Increased blood loss
  • Decreased bowel function
  • Respiratory complications
  • Longer hospital stay and recovery time
  • Adverse reactions to anesthesia

It can also increase your risk of complications in future pregnancies. However, having one C-section does NOT automatically mean you need to have a C-section for subsequent pregnancies.

This is another medical myth that most people, including doctors, have taken to heart as gospel.

Hopefully that is about to change. The National Institutes of Health (NIH) recently held a conference on this issue called the NIH Consensus Development Conference on Vaginal Birth After Cesarean: New Insights.

If you or someone you know has previously had a cesarean and is now pregnant again, you would be wise to read through their report and discuss the pro’s and con’s of trying for a vaginal birth with your obstetrician.

Although no new guidelines were reached, this conference has opened the door to further discussions by acknowledging that it may not be in the best interest of the mother or the baby to automatically do another C-section if she’s already had one.

Safe, Effective, Natural Birthing Options

It may come as a surprise to many, but merely putting yourself in the hands of a high-tech doctor and a high-tech hospital does not guarantee you the safest birth. In fact, there is not a single report in the scientific literature that shows obstetricians (specially trained surgeons) to be safer than midwives for low risk or normal pregnancy and birth.

If you are among the more than 75 percent of all women with a normal pregnancy, the safest birth attendant for you is likely not a doctor but rather a midwife or doula.

Below is a list of various sources to help you make your pregnancy and childbirth as safe and healthy as possible.

How to find a midwife, doula, or birth attendant:

Home birth resources:

  • The Home Birth Advantage by Dr. Mayer Eisenstein
  • www.elvovemd.com
  • Check your yellow pages or do a Google search for home birth providers in your area

Water birth resources:

Routine Mammograms May Cause Far More Harm than Good

I agree with Dr. Rita Redberg, editor of Archives of Internal Medicine, who wrote that “more care is not necessarily better care." And routine mammograms are a perfect example.

In my opinion, mammograms definitely expose you to potential harm while offering little to no benefit. It wouldn’t be so bad if mammograms were an effective cancer screen, but they’re not.

Health officials recommend that all women over 40 get a mammogram every one to two years, yet there is no solid evidence that mammograms save lives. Meanwhile the health hazards of mammography have been well established but are more or less ignored.

The Real Long-Term Dangers of Mammograms

John Gofman, M.D., Ph.D. – a nuclear physicist and a medical doctor, and one of the leading experts in the world on the dangers of radiation – presents compelling evidence in his book, Radiation from Medical Procedures in the Pathogenesis of Cancer and Ischemic Heart Disease, that over 50 percent of the death-rate from cancer is in fact induced by x-rays.

And here’s what the Cancer Prevention Coalition has to say about the dangers of mammograms (for reference sources, please see their web site):

“Radiation from routine mammography poses significant cumulative risks of initiating and promoting breast cancer.

Contrary to conventional assurances that radiation exposure from mammography is trivial— and similar to that from a chest X-ray or spending one week in Denver, about 1/ 1,000 of a rad (radiation-absorbed dose)— the routine practice of taking four films for each breast results in some 1,000-fold greater exposure, 1 rad, focused on each breast rather than the entire chest.

Thus, premenopausal women undergoing annual screening over a ten-year period are exposed to a total of about 10 rads for each breast.

As emphasized some three decades ago, the premenopausal breast is highly sensitive to radiation, each rad of exposure increasing breast cancer risk by 1 percent, resulting in a cumulative 10 percent increased risk over ten years of premenopausal screening, usually from ages 40 to 50; risks are even greater for "baseline" screening at younger ages, for which there is no evidence of any future relevance.

Furthermore, breast cancer risks from mammography are up to fourfold higher for the 1 to 2 percent of women who are silent carriers of the A-T (ataxia-telangiectasia) gene and thus highly sensitive to the carcinogenic effects of radiation; by some estimates this accounts for up to 20 percent of all breast cancers annually in the United States.”

To drive home this point further, consider this study published in 2000, conducted by the National Cancer Institute and the National Institutes of Health (NIH), titled: "Breast Cancer Mortality After Diagnostic Radiography.”

It examined the correlation of breast cancer mortality with receiving diagnostic x-ray exposure for scoliosis [curvature of the spine]. These women, who had an average of 25 diagnostic x-rays taken, had a 70 percent greater risk of dying of breast cancer than the general population.

One of the paper's key conclusions was:

"Consistent with radiation as a causative factor, risk of dying of breast cancer increased significantly with number of radiographic examinations in which the breast was exposed and with increasing cumulative radiation dose to the breast."

Yes, it IS possible that conventional medicine is actually promoting breast cancer by the very screening method it recommends as a “preventive” measure.

Paradoxically, when everything is taken into account, reducing exposure to medical radiation such as unnecessary mammograms would actually likely reduce mortality rates, which is the aim of cancer screening in the first place.

A Safer Alternative to Mammograms

Most physicians continue to recommend mammograms for fear of being sued, but I encourage you to think for yourself and consider safer, more effective alternatives to mammograms – especially if you are younger and have not already been diagnosed with, or undergone treatment for breast cancer.

The option for breast screening that I most highly recommend is called thermographic breast screening.

Thermographic screening measures the radiation of infrared heat from your body and translates this information into anatomical images. It does not use any mechanical pressure or ionizing radiation, and can detect signs of breast cancer as much as 10 years earlier than either mammography or a physical exam!

There are times when mammograms and x-rays are warranted, and thermography may not be a 100 percent replacement of these ionizing procedures in every instance.

However, as a part of your annual health prevention regimen, thermography is a FAR better alternative to mammograms.

One of its main strengths and benefits is early detection. Whereas mammography cannot detect a tumor until it has grown and reached a certain size, thermography is able to detect the possibility of breast cancer, before any tumors have formed.

It’s capable of this because it can provide a picture of the early stages of angiogenesis -- the formation of a direct supply of blood to cancer cells, which is a necessary step before they can grow into tumors of size.

And if you know you’re on the path toward developing a problem, you may have years to implement preventive measures to ensure cancer doesn’t become a reality.

For more information about thermography and other types of breast cancer screening options, please review this previous article. And for instructions on how to perform an effective breast self-exam, see this link.

10 Most Overused Tests

In addition to all the examples mentioned in the Seattle Times report above, three years ago Consumer Reports published a list of the 10 most overused medical tests and treatments, and not much has changed since then.

Their list includes:

  1. Back surgery
  2. Heartburn surgery
  3. Prostate treatments
  4. Implanted defibrillators
  5. Coronary stents
  6. C-sections
  7. Whole body screens
  8. High-tech angiography
  9. Mammography
  10. Virtual colonoscopy

For the reasons they give for each of these, please see the original article.


[+] Sources and References