Enter a new term into the midlife vernacular: medical gluttony. It's when our doctors order a barrage of "just in case" medical testing to keep us happy. It's a practice that ratchets up the cost of medical care in America -- not just for insurance companies, but also for patients in the form of deductibles and co-pays. And because medical tests and procedures frequently carry their own set of risks, it can actually cause more harm than do good.
Doctors, however, may not be where the problem originates. Boomers are a generation with a strong sense of entitlement and nowhere is this felt more than in our approach to medical care. We want no stone left unturned in determining what's wrong with us and once we know, we demand the latest and greatest medical testing and treatments known to man regardless of its cost. When we have a persistent headache, we want our doctor to test and rule out a brain tumor and when we are fatigued, we want tests to rule out Lupus, chronic fatigue syndrome, Lyme Disease and a host of other ailments we self-diagnose on WebMD.
Doctors are, of course, our willing co-conspirators in our medical gluttony; they may be practicing "defensive medicine" to avoid lawsuits or have a financial stake in the testing companies. We've all been there: You go to see the doctor with a simple complaint and it unleashes a torrent of blood work, scans, and in some cases, tests that expose you to more serious complications than the complaint that brought you to seek care in the first place.
When head of the Centers for Medicare and Medicaid Services Don Berwick resigned, he said almost 30 percent of health care spending was a "waste" with no benefit to patients. Overtreatment was one of the top reasons he cited. A study released this month by The Commonwealth Fund came to a simliar conclusion.
But the tide may be turning: Last month a group of nine medical specialty boards recommended that physicians cut back on 45 different tests and procedures.
How can tests do more harm than good? That's the premise of "How We Do Harm: A Doctor Breaks Ranks About Being Sick in America," a book by Dr. Otis W. Brawley, chief medical officer of the American Cancer Society. Brawley takes issue with doctors who prescribe too many tests, procedures and drugs.
In the book, he talks about the case of Ralph DeAngelo, whose medical odyssey began when his wife spotted an ad for a free prostate cancer screening and insisted he go. DeAngelo's results were found to be “significantly abnormal,” and in the course of his treatment, he had 12 biopsies; his prostate removed; and followup radiation therapy that created a hole between his rectum and bladder and required a colostomy. He later died of a urinary tract infection. Brawley said that the original free prostate specific antigen (more commonly known as PSA) test given to DeAngeleo, who was 72 when diagnosed and died five years later, showed a slightly elevated level of prostate-specific antigen -- something that may have been caused by an enlarged prostate gland common in older men -- and not cancer.
It was a case of overtreatment, said Brawley, and unfortunately not atypical. He notes that prostate cancer screenings have been done since 1991, but the first study showing that they even might be beneficial wasn't done until 2010.
Brawley also points to breast cancer treatment. For 20 years, breast cancer patients were routinely treated with a bone-marrow transplant and high-dose chemotherapy regimen. In the late 1980s, women en masse sued their insurance companies to get them to pay for it. Only later, in 1999, after four studies showed that having bone-marrow transplants was actually harmful in treating breast cancer, did the procedures stop. Within four months of the studies' release, 220 centers stopped doing them. Brawley said that 60,000 women had the procedure done in 1998 alone; none got it in the year 2000. Yet 10 states still have laws on the book requiring insurers to pay for them.
People, especially post 50s, Brawley said, "believe that the newest treatments must always be better than the older ones. Boomers believe that they simply must have the newest surgical techniques, even if they don't really need them." He points to coronary artery grafting -- bypass surgery -- as an example. There are many people who would have been just as fine with medical management of their clogged arteries, he said, but instead are subjected to -- and want -- the bypass surgeries. "We have done this time and time again in history. Too many tonsilectomies, too many tubes put in kids' ears -- even now we treat colds and viruses with powerful antibiotics that later weaken our bodies' ability to fight off more serious infections with them."
Brawley notes that while United States holds the No. 1 spot for health care spending, it ranks 50th among all nations in life expectancy.
So what's the answer? Politicians have been scaring folks with talk of rationing medicine. Maybe the discussion should be about the rational use of it instead.
Check out the slideshow below for a dozen medical tests that can be avoided, according to the group Choosing Wisely.
Electrocardiograms, better known as EKGs, made the Choosing Wisely list. The painless test is "done routinely during a physical, even when there is no sign of heart trouble," <em> <a href="http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html">The New York Times</em> reports</a>.
Proton Pump Inhibitors
These strong drugs prescribed for severe heartburn often make their way into the hands of of those with only a slight case of discomfort. "High doses of [proton pump inhibitors], 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," <a href="http://consumerhealthchoices.org/wp-content/uploads/2012/05/ChoosingWiselyHeartburnAGA2.pdf">Choosing Wisely reports</a>.
When it comes to lower back pain, doctors shouldn't use M.R.I.s within the first six weeks of a patient's complaints unless "red flags are present," <a href="http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_Acad_Fam_Phys.pdf"> according to the American Academy of Family Physicians</a>.
That flareup of sinusitis -- an inflammation of the sinuses -- probably doesn't need a round of antibiotics for treatment, the report found.
"Women older than 65 who have had several normal Pap tests can stop having the test," <a href="http://consumerhealthchoices.org/wp-content/uploads/2012/05/ChoosingWiselyPapTestsAAFP.pdf">according to Choosing Wisely</a>.
Now doctors are advised to not use this test "as a routine follow-up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms," <a href="http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_Coll_Cardio.pdf">according to the Choose Wisely report</a>.
Getting imaging tests like CT scans for headaches are not terribly helpful. "Research shows that for people with a normal medical history and neurological exam, imaging tests are unlikely to reveal a more serious underlying problem," <a href="http://consumerhealthchoices.org/wp-content/uploads/2012/04/ChoosingWiselyHeadachesACR.pdf">according to the Choosing Wisely report</a>.
Bone Density Imaging
If you don't have a high risk for weak bones (70 years old for men and 65 for women), you may want to demur if your doctor recommends bone density imaging. The test can lead to a diagnosis of osteopenia, a condition with risky drug prescriptions that can lead to side effects such as thigh fractures and abnormal heart rhythms, <a href="http://consumerhealthchoices.org/wp-content/uploads/2012/05/ChoosingWiselyBoneDensityAAFP.pdf">the Choosing Wisely report found</a>.
Exercise Stress Test
Besides being expensive, an unnecessary exercise stress test "can produce inaccurate results that trigger follow-up tests that can pose risks," the report found.
Surveillance Testing (Biomarkers)
While this form of testing can help colorectal cancer sufferers, doctors are now advised not to use it on breast cancer patients who are being treated with "curative intent." "False-positive tests can lead to harm through unnecessary invasive procedures, over-treatment, unnecessary radiation exposure, and misdiagnosis," <a href="http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_Soc_Clin_Onc.pdf">the report found</a>.
"Kidney disease doctors are urged not to start chronic dialysis before having a serious discussion with the patient and family," <a href="http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html"><em>The New York Times</em> reports</a>.
Acid Reflux Medicine
"The American Gastroenterological Association is urging its physicians to prescribe the lowest doses of medication needed to control acid reflux disease," <a href="http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html"><em>The New York Times</em> reports</a>.
If a patient isn't exhibiting any heart and lung disease symptoms, chest radiography should not be performed. "Preoperative chest radiography rarely provides any meaningful changes in management or improved patient outcomes," <a href="http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_College_Phys.pdf">the American College of Physicians found.</a>
White Blood Cell Stimulating Factor
For patients with neutropenia (a condition characterized by "<a href="http://www.mayoclinic.com/health/neutropenia/MY00110">an abnormally low count of neutrophils</a>, white blood cells that help your immune system fight off infections"), doctors shouldn't inject white blood cell stimulating factor to stave off fever if they have a less than 20 percent risk for this complication.
Colorectal Cancer Screening
Patients don't need to have a "repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals," <a href="http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_AGA.pdf" target="_hplink">advises the American Gastroenterological Association</a>.
If a patient with <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002128/">Barrett's esophagus</a>'s first endoscopy reveals zero signs of cell change, doctors should only use an endoscope once every three years, the report found. "If these cellular changes occur, they do so very slowly."