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Old 10-21-2007, 09:08 AM
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Unecessary Healthcare Procedures

From http://www.itsasurvey.com/artman2/publish/medical/Consumer_Reports_Ten_Overused_Medical_Tests_and_Treatments.shtml

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Consumer Reports: Ten Overused Medical Tests and Treatments

Oct 1, 2007 - 6:46:32 PM

A new Consumer Reports investigation, published in the November issue, identifies 10 "Overused Tests and Treatments" and spells out how consumers can navigate a health-care system that rewards costly -- and often unnecessary -- tests and procedures and de- emphasizes preventive care.

The CR investigation identifies three main problems in the U.S. health- care system: unnecessary tests and treatments; costly new drugs that are often no better than the older, cheaper ones; and a glaring under-appreciation for preventive care. The investigation is the second in a series about health care. The theme of dysfunctional profit incentives was brought to light in the first installment, published in September, in which CR took note of the deteriorating ability of insurance companies to slow the growth of medical costs since 2000. The annual U.S. health-care bill, reports CR, has risen to $2 trillion, its highest point in history.

Ten Overused Tests and Treatments

For consumers unfamiliar with the term "fee for service," CR explains: Because the vast majority of doctors and hospitals are paid on a piecework basis, the more services they provide, such as blood tests, surgeries, MRIs, and CT scans, the more money they make. Experts estimate that the nation's $2 trillion annual health-care tab is one-third to one-half higher than need be, in part because of overuse of expensive treatments and unnecessary care. CR's overused tests and treatments are listed below:

1. BACK SURGERY: Don't rush to surgery for a simple slipped disc. In 90 percent of cases, the pain goes away on its own within six weeks. In stubborn cases, surgery, which can cost $20,000 plus physician fees, can relieve pain somewhat faster than physical therapy and medication, a recent study showed. But the study notes that both groups of patients wound up with similar improvements after two years.

2. HEARTBURN SURGERY: A surgical tightening of the sphincter muscle that blocks stomach acid from backing up into the esophagus typically costs $14,600 or more, and provides no better long-term relief than taking a proton-pump- inhibitor drug, which costs less than $1 a day.

3. PROSTATE TREATMENTS: Prostate cancer surgery can cost $17,000 or more and is often done without adequate discussion of the alternatives or the high risk of incontinence or impotence.

4. IMPLANTED DEFIBRILLATORS: One-third of people who get these devices might not really need them, research shows. This year Medicare will pay for an estimated 50,000 of the devices, which automatically shock the heart back to a normal rhythm (each costs some $90,000 over a lifetime).

5. CORONARY STENTS: Billions are spent each year inserting tiny mesh tubes to prop open coronary arteries. But the procedure plus heart drugs turns out not to work any better to prevent future heart attacks than heart drugs alone for patients with stable coronary artery disease, research shows.

6. CESAREAN SECTIONS: At a cost of $7,000-approximately 55% more than natural delivery -- most cesarean sections are performed because labor is progressing too slowly. Cesarean sections were used for a record high of 30.2% of births in 2005. But several less-invasive approaches might be enough to speed up labor.

7. WHOLE-BODY SCREENS: These CT scans, at a cost of $1,000 or more, have no proven benefits for healthy people, according to the Food and Drug Administration. Plus, CT scans expose patients to far more radiation than X- rays.

8. HIGH-TECH ANGIOGRAPHY: Using a CT scan to noninvasively check coronary arteries for narrowing costs an average of $450, according to data from HealthMarkets, which sells health and life insurance through subsidiaries in 44 states. But standard angiography is sometimes still needed to confirm blockages that might require aggressive treatment.

9. HIGH-TECH MAMMOGRAPHY: Using software to flag suspicious breast X-rays would add $550 million a year to national costs if used for all mammograms. A 2007 study found it failed to improve cancer detection rates significantly while resulting in more needless biopsies.

10. VIRTUAL COLONOSCOPY: A study in 2007 concluded that standard colonoscopy is better at spotting smaller suspicious polyps. While less costly than the standard procedure, virtual colonoscopy isn't cost-effective because any suspicious finding requires retesting with the real thing.


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Old 10-22-2007, 02:04 AM
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"5. CORONARY STENTS: Billions are spent each year inserting tiny mesh tubes to prop open coronary arteries. But the procedure plus heart drugs turns out not to work any better to prevent future heart attacks than heart drugs alone for patients with stable coronary artery disease, research shows."

I know I wondered about that one. I read something about this after I had my first angioplasty done back in '96. But I also know I'd be dead if it wasn't done. No way drugs could have re-opened my artery, then, or the angio I just had done a few months ago. So I don't know what they're getting at. Are some doc's putting in stents waaaay before there's serious symptoms?
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Old 10-22-2007, 07:14 AM
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Quote:
Originally Posted by rickg View Post
"5. CORONARY STENTS: Billions are spent each year inserting tiny mesh tubes to prop open coronary arteries. But the procedure plus heart drugs turns out not to work any better to prevent future heart attacks than heart drugs alone for patients with stable coronary artery disease, research shows."

I know I wondered about that one. I read something about this after I had my first angioplasty done back in '96. But I also know I'd be dead if it wasn't done. No way drugs could have re-opened my artery, then, or the angio I just had done a few months ago. So I don't know what they're getting at. Are some doc's putting in stents waaaay before there's serious symptoms?
I think you and I know, Rick, that many patients with stents are there because they didn't take care of themselves in the first place, and sometimes even life changing events can't alter behavior.

Take my FIL for example. Triple bypass last year, today he doesn't seem to want to get out of his Lazyboy chair. He still thinks something is low fat if there's no grease on the plate.
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Old 10-22-2007, 01:23 PM
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10. ?

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