“The more scans you do, the more money you make. If I do eight PET scans a day, that’s two million dollars a year, or a 35 percent profit margin… But we don’t use the word ‘profit’ in hospitals; it’s called surplus.” – a doctor, Brownlee (2008) Overtreated
The Institute of Medicine (US) estimates that an astonishing $200bn is wasted annually on unnecessary tests. But this is probably actually a conservative estimate. Another study, conducted by the Center for Evaluative Clinical Sciences, puts the figure at $800bn – four times that amount.
We have an obsession with being tested because we are scared to death of missing something that might kill us. Good doctors are complicit because they fear being sued for missing something. But unnecessary screening is not just an expensive case of erring on the side of caution. Top journals have reported that early screening leads to unnecessary surgery.
“I’m one of the women you rarely hear from, a woman who years ago underwent invasive and disfiguring breast surgery to remove a “suspicious mass” that had been identified via mammogram, but turned out to be a perfectly benign and harmless little nothing. Not only did I have to endure this deforming surgical procedure, but I also had to suffer the same extreme anxiety, fear and emotional trauma that any woman faces before going into surgery…
When the outcome turns out to be “Never mind! It’s nothing!”, relieved patients are then expected to be grateful to the brilliant surgeons who “saved” us, and the brilliant radiologists who over diagnosed us.
How many more of us are there out there?”
(From an online forum, replicated in the book Doctoring Data (2014) by Malcolm Kendrick.)
No one knows how many people are operated on and disfigured in error, but the routine PSA test was discontinued because it turned out so many false positives for prostate cancer that men were being made impotent and incontinent left and right for nothing! After the age 75, half of males may have prostate cancer, but only 2% die from it. To add insult to injury the system will no doubt mark those injured in their “success” rates even though most of them could have lived out the rest of their life with prostate cancer and without health complaints resulting. A 1993 study in Journal of the American Medical Association concluded that no treatment at all for prostate cancer was better than any standard chemotherapy, radiation, or surgical procedure! As tests have their way of leading to more tests, unnecessary screening also leads to cumulative radiation exposure.
Most cancers are not even found until people are autopsied, because they never caused any noticeable symptoms. Perhaps 30-40 times as many cases of thyroid, pancreatic, and prostate cancer are found in dead people than ever presented to the doctor.
There’s a difference between being tested because for a specific health complaint and screening “just in case.” If you are worried about something, by all means get it checked, but don’t assume random screening will help you. For example, the US preventative services taskforce found that the risks of annual mammograms outweighed the benefits in women under 50, so they moved to recommending bi-annual screenings instead – how many breasts were removed unnecessarily first?
We all want to err on the side of caution, but when it comes to unnecessary testing can you actually tell what the right side of caution is?
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Please share this article with loved ones – I am not doing this for my own health (lol geddit?)
