Thursday, February 21, 2013

Which Routine Medical Tests and Treatments Should You Avoid?

Often when you go to a doctor with a problem, you expect tests and a prescription. Such actions are not always the best course of action and can sometimes be counterproductive. Unnecessary tests can lead to more expensive, time-consuming, stressful, and sometimes painful tests with side effects that could have been avoided. Medications have side effects and if you don't need a drug, you shouldn't take it.  But how do you know which tests to avoid?

Choosing Wisely® is an initiative of the American Board of Internal Medicine Foundation to help physicians and patients engage in conversations to reduce overuse of tests and procedures, and support physician efforts to help patients make smart and effective care choices.

A new list of tests and treatments to avoid was released last week. The entire list is listed below with links to the sites.

I find the lists to be very thoughtful and well developed. That doesn't mean that they are gospel or infallible. Physicians must continue to use their clinical judgment to make the right decisions for their patients. I hope the information provided makes you a smarter patient, one capable of asking the right questions from your doctor to get the best care for you or a loved one. Avoiding unnecessary tests and treatments is as important as receiving the right ones. It is worthwhile to familiarize yourself with all the tests so if you ever find yourself in a situation where such a test is being recommended for you or a family member, you are more knowledgeable and better prepared to decide.

Patient-Friendly Resources from Specialty Societies and Consumer Reports:
Download PDF It’s worth getting a bone-density test if you’re older or have other risk factors for weak bones, because without it the first sign of osteoporosis is usually a broken bone. But if you’re not at higher risk, you should think twice about the test. Here’s why:
The test usually isn’t necessary in younger people without risk factors for weak bones.
Many women and some men are routinely screened for weak bones with an imaging test called a dual-energy X-ray absorptiometry (DEXA) scan. If it shows that you have outright osteoporosis, the results can help you and your doctor decide how to treat the problem, usually with drugs. But many people learn they have only mild bone loss, a condition known as osteopenia, and for them the risk of fracture is often quite low.
It can pose risks.
A DEXA scan isn’t likely to harm you directly. But a diagnosis of osteopenia can lead to treatment with such drugs as alendronate (Fosamax and generic), ibandronate (Boniva and generic), and risendronate (Actonel, Atelvia, and generic), which pose numerous risks. Those include thigh fractures; throat or chest pain; difficulty swallowing; heartburn; and more rarely, bone, eye, joint, and muscle pain; bone loss in the jaw; and possibly abnormal heart rhythm. In addition, there is little evidence that people with osteopenia get much benefit from the drugs. Other types of osteoporosis drugs are linked to risks such as blood clots, heart attacks, strokes, and serious infections.
It can be a waste of money.
A DEXA scan costs about $132, according to Though that isn’t as expensive as some tests, any money spent on unnecessary tests is money wasted. In addition, a month’s supply of generic alendronate costs $38 to $70. Fosamax, the brand-name version, costs $125 to $148. People often take the drugs for years and sometimes indefinitely.
So when is the test warranted?
Women should have their bone density measured at age 65. Men 70 and older might also want to talk with their doctor about the test. Women younger than 65 and men 50 to 69 should consider it if they have risk factors such as a fracture from minor trauma, rheumatoid arthritis, a parent who had a hip fracture, or a history of smoking, heavy drinking, or long-term use of corticosteroid drugs. Whether you need a follow-up bone-density test depends on the results of the initial scan.

Treating heartburn and GERD

Use Nexium, Prilosec, and related drugs carefully
Download PDF If you have heartburn, or a feeling of burning pain in your upper abdomen or lower chest, you might be tempted to try a powerful drug such as Nexium, Prevacid, or Prilosec. Those drugs, called proton pump inhibitors (PPIs), can be good choices for severe or frequent heartburn. But in most cases PPIs aren’t necessary. And when they are, consider using the lowest dose necessary for as short a time as possible. Here’s why:
You might not need a PPI.
A PPI can help if you have heartburn more than twice a week for several weeks, or a condition called gastroesophageal reflux disease (GERD). But studies suggest that up to 70 percent of people taking a PPI were never diagnosed with GERD. Instead, they might have less serious heartburn, which can often be eased with dietary and other lifestyle changes and, if necessary, antacids like Rolaids and Tums or another class of medication, known as H2 blockers, such as Pepcid AC and Zantac.
The drugs can pose risks.
High doses of PPIs, and taking them for a year or longer, has been linked to an increased risk of bone fractures. Long-term use might also deplete magnesium blood levels, which, in turn, can trigger muscle spasms, irregular heartbeats, and convulsions. Another complication of long-term use is an intestinal infection called Clostridium difficile that can lead to severe diarrhea, fever and, in rare cases, death. PPIs can also interact with other medications. For example, omeprazole (Prilosec) can reduce the blood-thinning effect of the drug clopidogrel (Plavix), which can increase the risk of heart attack and even death. Esomeprazole (Nexium), and the H2 blocker, cimetidine (Tagamet), might also interact with Plavix in that same way.
PPIs cost more.
A month’s supply of a prescription strength PPI could cost you about $100 to $300 more than you would pay for antacids or an H2 blocker. A low-dose, over-the-counter PPI such as Prilosec OTC or store-brand or generic version, costs less than the prescription options, but still runs about $10 more a month than the other heartburn drugs.
When should you consider a PPI?
Talk with a doctor if you have heartburn at least twice a week for several weeks, if you often regurgitate food into your throat, or if your heartburn is not relieved by lifestyle changes and antacids or H2 blockers. When a PPI is necessary, start with a low dose of omeprazole or Prilosec OTC (15 mg) or Prevacid 24HR (15 mg). If symptoms improve, consider taking a break after a few weeks. To reduce the risk of rebound heartburn, gradually lower your dose, try taking it every other day, or take an antacid.

One final thought. The next time you think that all doctors want is to make more money, think of the many doctors involved in forming these lists for the sole purpose of sparing patients from the costs and hardships of wasteful testing and treatments. The medical profession is not perfect and it has its problem practitioners, but concerted efforts like these give me hope for a better tomorrow.

1 comment:

  1. New Diet Taps into Pioneering Idea to Help Dieters Get Rid Of 23 Pounds in Just 21 Days!