Consumer Reports: Ten Overused Medical Tests and Treatments

How U.S. Health Care Bill Got To Record-Breaking $2 Trillion: Too Much

Treatment, Too Many Drugs, And Too Little Preventive Care

Oct 01, 2007, 01:00 ET from Consumer Reports

    YONKERS, N.Y., Oct. 1 /PRNewswire-USNewswire/ -- 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
     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.
     CR's Recommendation: Consumers should designate one doctor, typically a
 primary-care physician, to coordinate care. Patients should ask which
 treatments have been shown by research to be best for their given
 condition. And when tests are performed, inquire what the consequences are
 if the results are positive.
     Influx of New Drugs That Aren't Necessarily Breakthroughs
     The pharmaceutical industry spends an estimated $29.9 billion a year
 promoting newer brand name prescription drugs. But CR notes that despite
 the billions spent on promotional activities such as direct-to-consumer
 ads, free samples, and showering physicians with gifts and cash, newer
 drugs aren't always better. In fact, for a manufacturer to secure FDA
 approval of a new drug, it need only prove that the drug works better than
 a sugar pill, not that it's better than other remedies. So most of the
 "new" drugs that the FDA approves-75 percent in 2005-are me-too versions of
 existing remedies rather than genuine breakthroughs.
     CR's Recommendation: Consumers should ask their doctors for generic
 drugs whenever possible. When offered a newer drug, its best to ask if it
 has been proven better or safer than its predecessors. A free Consumers
 Union Web site, Best Buy Drugs, provides comparative treatments and cost
 information on most major categories of drugs, based on analysis of
 published studies of the drugs' effectiveness and safety. Log on to
     Shortchanging The Basics, De-Emphasizing Preventive Care
     As a consequence of a payment system that discourages prevention and
 management of care, Americans spent almost $29 billion on 4.4 million
 hospital stays for potentially preventable conditions in 2004, according to
 a recent study. Health-care costs are ballooning partly because the system
 is geared toward expensive interventions and remedies after health problems
 develop. The U.S. doesn't have a system in place, notes one doctor, for
 rewarding the education of patients as to why it's important to change
 behavior to improve their health. And many new physicians are avoiding the
 primary care field altogether; new medical student graduates, often saddled
 with six-figure student loans, are increasingly opting to forsake primary
 care for the bigger paycheck of a specialist.
     CR's Recommendation: Consumers should take lifestyle changes seriously,
 especially if they're at risk for heart disease, stroke, diabetes, or
 cancer. People with a chronic disease should work with their doctor to
 devise an effective plan to manage it.
     NOVEMBER 2007
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 purposes. Consumer Reports(R) is published by Consumers Union, an expert,
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 just, and safe marketplace for all consumers and to empower consumers to
 protect themselves. To achieve this mission, we test, inform, and protect.
 To maintain our independence and impartiality, Consumers Union accepts no
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SOURCE Consumer Reports