Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

We are overdosing on medical tests

Dr. Joe Kosterich
Physician
June 23, 2012
Share
Tweet
Share

Once upon a time people only went to the doctor when they felt sick. For most of human existence there was not much the doctor could actually do when you got there. Yet somehow the human race managed to get through to the second half of the twentieth century when things changed completely.

As technology advanced exponentially we developed a range of treatments so that conditions, which used to be fatal could now be cured. Penicillin as a treatment for bacterial infections is the best example of this. Surgical techniques also improved beyond measure, as did the safety of anaesthesia.

Coupled with this came the advance of medical tests so that disease could be found earlier. People were encouraged to go to the doctor early, as the sooner problems were detected the better. This makes good sense. It is better to treat most conditions in their early rather than advanced stages.

Then it all went one step further.

Medicine started treating people who did not actually have symptoms but had risk factors. High cholesterol and high blood pressure are examples of this. You only know you have it if you are tested or measured (some people do have symptoms with high blood pressure but only when it is very high).

The last step was to launch mass screening programs so people didn’t even need to go to the doctor for testing.

The theory is that the more we find at an early stage the better for all concerned.

Except that nothing in medicine is a straight line. If a little is good more may be better, but a lot more is not necessarily better and can be worse. Every drug has an effective dose and then there is potential overdose. We all know that an overdose is a problem and can be a serious one too.

Collectively we are overdosing on tests. And whilst the logic that finding things early seems flawless the reality is that it is flawed. There are a number of reasons for this.

1. Not everything that is found is actually a sign of disease. Incidentalomas are the medical term for incidental findings, which have no clinical significance, but if unearthed end up needing further tests to prove that this is the case. More tests can mean both more expense but also worry and the risk of complications or side effects.

2. Our capacity to interpret has exceeded our ability to find. It is likely that every person has a cancer cell somewhere in their body on any given day but they will never manifest as cancers. Over 30% of breast cancers found on screening represent over diagnosis. This is where the cancer, which is found, would not have manifested in the persons life or caused them any health problems. Around 50 men have prostate cancer surgery for every one who has their life extended or improved.

3. The lowering of thresholds brings more people into the “disease” category. Every time normal levels for cholesterol, blood pressure or blood sugar are lowered a whole new group of people can be reclassified as having a condition and hence a candidate for treatment.

4. Historically treatment benefits were determined on more severe cases. For example a person with a blood pressure of 200 gets much more benefit from lowering the pressure than someone with a pressure of 145. Yet both are classed as hypertensive and in equal need of treatment.

ADVERTISEMENT

5. The reclassifying of normal body processes as a disease. Menopause  (a normal part of life) was a classic example of this. Osteoporosis is another. Bones get “thinner” for many as we age. This is not a disease. Mental health diagnoses (like oppositional defiance disorder) is a whole article in itself.

6. Treatments can do harm. Surgery can have complications and medications have side effects. These can be justified where benefit outweighs risk. The wider we cast the net and the milder and less significant the “abnormalities” the greater the chances of harm outweighing benefit. The prostate example above is compounded by the fact that a reasonable number of men may end up incontinent and/or impotent post surgery. This is acceptable if you might live for an extra ten years but not if your life is neither extended nor enhanced. Elderly people treated for marginally high blood pressure may fall and sustain injuries. This is potentially far worse than having a slightly elevated blood pressure.

This is not an argument against treating people who need it and who would benefit. It is against the reclassifying of well people as diseased and the notion that everyone has something wrong with them until they have been screened to prove otherwise.

Early diagnosis is not the same as over-diagnosis. The medical industrial complex is over–reaching its mark and doing collateral damage to people who were well till they got drawn into the net. Nine American Colleges have produced a website called Choosing Wisely making the case for not doing certain procedures tests or treatments routinely. This problem is not confined to the USA.

Rather than see health as an absence of disease we need to see health as the presence of wellbeing. This is in the hands of the individual on a daily basis and is about how they eat, exercise, rest, and manage their stress and the other basics of health.

The best way not to be sick is to be healthy.

Joe Kosterich is a physician in Australia who blogs at Dr. Joe Today.

Prev

Verbalizes understanding: What exactly does it mean?

June 23, 2012 Kevin 5
…
Next

MKSAP: 68-year-old woman with the sudden onset of severe pain

June 24, 2012 Kevin 0
…

Tagged as: Cardiology, Primary Care

Post navigation

< Previous Post
Verbalizes understanding: What exactly does it mean?
Next Post >
MKSAP: 68-year-old woman with the sudden onset of severe pain

ADVERTISEMENT

More by Dr. Joe Kosterich

  • a desk with keyboard and ipad with the kevinmd logo

    ADHD medications: Performance enhancing drugs of the mind

    Dr. Joe Kosterich
  • a desk with keyboard and ipad with the kevinmd logo

    There is scope for harm when ordering tests

    Dr. Joe Kosterich
  • a desk with keyboard and ipad with the kevinmd logo

    The problem with early detection of disease in medicine

    Dr. Joe Kosterich

More in Physician

  • Public health under fire: Vaccine battle hits federal court

    J. Leonard Lichtenfeld, MD
  • How mindful leadership transforms physician wellness

    Jessie Mahoney, MD
  • How the quietly efficient physician can turn perception into power

    Olumuyiwa Bamgbade, MD
  • a desk with keyboard and ipad with the kevinmd logo

    The heart was fine—but something deeper was wrong

    Dr. Riya Cherian
  • The unfiltered truth about surviving emergency medicine residency with purpose

    Dr. Rida Jawed
  • Why primary care doctors are drowning in debt despite saving lives

    John Wei, MD
  • Most Popular

  • Past Week

    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • Aging in place: Why home care must replace nursing homes

      Gene Uzawa Dorio, MD | Physician
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • When the clinic becomes the battlefield: Defending rural health care in the age of AI-driven attacks

      Holland Haynie, MD | Physician
    • How motherhood made me a better scientist [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • How motherhood made me a better scientist [PODCAST]

      The Podcast by KevinMD | Podcast
    • Public health under fire: Vaccine battle hits federal court

      J. Leonard Lichtenfeld, MD | Physician
    • How mindful leadership transforms physician wellness

      Jessie Mahoney, MD | Physician
    • How the quietly efficient physician can turn perception into power

      Olumuyiwa Bamgbade, MD | Physician
    • Are we repeating the statin playbook with lipoprotein(a)?

      Larry Kaskel, MD | Conditions
    • Why our fear of AI is really a fear of ourselves [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • Aging in place: Why home care must replace nursing homes

      Gene Uzawa Dorio, MD | Physician
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • When the clinic becomes the battlefield: Defending rural health care in the age of AI-driven attacks

      Holland Haynie, MD | Physician
    • How motherhood made me a better scientist [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • How motherhood made me a better scientist [PODCAST]

      The Podcast by KevinMD | Podcast
    • Public health under fire: Vaccine battle hits federal court

      J. Leonard Lichtenfeld, MD | Physician
    • How mindful leadership transforms physician wellness

      Jessie Mahoney, MD | Physician
    • How the quietly efficient physician can turn perception into power

      Olumuyiwa Bamgbade, MD | Physician
    • Are we repeating the statin playbook with lipoprotein(a)?

      Larry Kaskel, MD | Conditions
    • Why our fear of AI is really a fear of ourselves [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

We are overdosing on medical tests
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...