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Is your medical procedure necessary?

What if millions of medical diagnoses, procedures, and treatments were based on, at best, questionable scientific evidence, but still performed daily, the world over, in the name of saving patients lives or reducing their suffering? A new JAMA review indicates this may be exactly what is happening. 


 

A disturbing new review published in JAMA online about overuse of medical care, i.e., health care where “risk of harm exceeds its potential for benefit,” concludes that many common medical procedures, given to millions are subjected to each year, have questionable or even non-existent evidence.

According to the review, co-authored by researchers from some of the country’s most respected medical institutions, medical overuse can also be defined as ‘a health care practice, about which when patients are fully informed, they would choose to forego care’. They go further:

Medical Overuse encompasses over diagnosis, which occurs when “individuals are diagnosed with conditions that will never cause symptoms,” and over treatment, which is treatment targeting over diagnosed disease or from which there is minimal or no benefit.”

Obviously when information is withheld on the real risks and benefits of a procedure, the whole principle of informed consent is violated. It’s a far too common occurrence in today’s medicine where money competes with scientific evidence to drive the doctor’s consensus that determines standard of care. It appears published biomedical literature is so corrupted by industry influence, and bias, that the entire ideal of ‘Evidence-Based Medicine” is in reality based on no more than a coin’s flip worth of certainty.

There’s also the more insidious problem of the mis-classification or misunderstanding of disease. This can mislead health care professionals and their patients into performing or undergoing harmful procedures without anyone understanding and accepting the harm and even lethal result they have wrought.

Over the past eight years,  a vast, submerged iceberg of overdiagnosed and overtreated medical conditions, with the worst examples being common forms of breast, prostate, thyroid, and ovarian cancer has been identified. It wasn’t till 2013 that the issue broke open.

A National Cancer Institute commissioned expert panel acknowledged that early-stage or ‘stage zero’ breast (DCIS) and prostate (HGPIN) “cancers” are actually benign or indolent lesions of epithelial origin and should never have been, and should never be, termed “carcinomas.”

Summarizing, the report revealed that millions have been wrongly diagnosed and treated for breast and prostate cancers over the past few decades that they never had. In the case of stage zero breast ‘cancer’, some 1.3 million American women were subjected to sa combination of either mastectomy, lumpectomy, radiation, and chemotherapy over the past 30 years, even though their screen-detected condition had no symptoms. Left untreated this would likely never have caused them any harm. It doesn’t even account for the radiobiological harm caused by x-ray mammography. This could well have planted the seeds of malignancy into the healthy breasts of millions of women in the name of “prevention through early detection.”

The  study, titled “Update on Medical Practices That Should Be Questioned in 2015,” reviewed 910 articles published in 2014, of which 440 directly addressed medical overuse. 104 of these were selected as “most relevant,” with the 10 most influential articles selected by author consensus, and forming the basis for their 10-topic critique, which is divided into three sections: overdiagnosis, overtreatment, and methods to avoid medical overuse.

Overdiagnosis:

  • Asymptomatic Carotid Stenosis: Colloquially known as “blocked or restricted arteries in the neck,” carotid artery stenosis often presents with no symptoms (asymptomatic), and yet is routinely treated with carotid angioplasty and stenting (placing a balloon or stent within the artery to open it) or surgical endarterectomy (removal of the inner lining of the artery and obstructive deposits found there) as “precautionary measures.” The review referenced a systematic review and meta-analysis by the US Preventive Services Task Force that found no studies providing data on whether screening for carotid stenosis reduced stroke. What was found is that carotid ultrasonography screening leads to many false-positives; a finding that I believe, contributes to increased morbidity and mortality in screened populations. This is especially apparent when you consider that safe and effective non-surgical alternatives exist: pomegranate juice has been found to reverse carotid artery stenosis within only months!
  • Screening Pelvic Examinations Are Inaccurate in Asymptomatic Women and Are Associated With Harms That Exceed Clinical Benefits.
    Pelvic examination is often included in annual preventive visits for women and usually consists of both visual examination and the insertion of the hand and instruments like a speculum in the vagina. This soft-tissue evaluation includes the upper genital tracts, as well as urethra, bladder, and rectum. Amazingly, a cited review found no studies assessing the effect of pelvic examinations on morbidity or mortality from cancers (including ovarian cancers) or benign gynecological conditions. Moreover, it was found that the harms of screening include “discomfort, anxiety, psychological effects, embarrassment, and unnecessary procedures, including surgery (1.4% [29 of 2000] of women in one study).”  The review opined strongly about the study implications: “Do not perform screening pelvic examinations. Clinicians should educate female patients about the low value of the examination. This review informed a new guideline from the American College of Physicians recommending against routine pelvic examinations for screening asymptomatic women.” [emphasis added] Given the lack of evidence supporting pelvic examinations, could the practice be considered just another form of the violation of women by medical care providers, not unlike unnecessary C-sections?
  • Head Computed Tomography Is Often Ordered but Is Rarely Helpful:
    Computer tomography uses ionizing radiation and sometimes a contrasting agent in diagnosis, both of which have significant potential to cause adverse health effects. Often CT scans produce incidental, and clinically unimportant findings, and will lead to additional CT scans being ordered. The review concluded, “A second head CT scan rarely affects patient management. Clinicians should be judicious in ordering multiple CT scans in the same patient.” Consider also, that a study published in the NEJM in 2007 estimated that .4% of all cancers in the US may be attributable to CT scans!
  • Thyroid Cancer Is Massively Overdiagnosed, Leading to Concrete Harms:
    In the past 30 years, there has been a global increase in the implementation of thyroid cancer screening programs which have lead to dramatically increased rates of diagnosis of “thyroid cancer,”mostly due to papillary carcinomas, which are non-fatal.  Thyroid cancer mortality rates remained the same throughout this period, a clear indication of overdiagnosis, i.e. the thyroid lesions were non-cancerous insofar as they would have never caused harm if left untreated. The review cited a new study that reviewed the 15-fold increase in thyroid cancer in South Korean, from 1993 to 2011, concluding that, “Overdiagnosis of thyroid cancer is extremely common. The harms associated with this overtreatment include lifelong thyroid replacement, hypoparathyroidism, and vocal cord paralysis.” Learn more by reading my article, “Thyroid Cancer Epidemic Caused by Misinformation, Not Cancer.”Ian: Is it any wonder we as ordinary mortals are resorting to alternative methods? While the efficacy and medical veracity may often be in question, it’s, to my mind, healthy in that whatever the form, people are taking responsibility for future health away from the medical establishment.

 

Full report here

Author Sayer Ji is founder of Greenmedinfo.com, where this article first appeared. He is on the Board of Governors for the National Health Federation, and Fearless Parent, Steering Committee Member of the Global GMO Free Coalition (GGFC), a reviewer at the  International Journal of Human Nutrition and Functional MedicineLike on Facebook – Follow on Twitter 

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