A new Pro Publica report explains how even when the data show that the best treatment for a health condition is exercise, a healthy diet and lifestyle changes, a large proportion of doctors continue to deliver medical treatments that are unnecessary, unhelpful and sometimes harmful. It’s well worth a thorough read. Here’s the big takeaway: When your doctor is proposing a new medication or an invasive procedure, it’s wise to question your doctor’s orders.
What’s the problem? Doctors may not stay on top of the latest science, or they may not believe the new findings, or they may have a financial incentive to perform an unnecessary procedure. Doctors and patients also often focus on the purported benefits of a medication or procedure or see the treatment as at worst neutral, without giving adequate attention to its risks.
How big is the problem? The problem is enormous, affecting millions of people and concerning a wide range of treatments. The report describes, among other things, the unnecessary and often risky implantation of stents in patients in stable condition who have not suffered heart attacks, the extensive prescribing of atenolol to prevent heart disease and stroke, when it has been shown not to do so, and the frequency of arthroscopic surgery to fix meniscus tears when physical therapy appears to be the appropriate treatment.
The problem with stent implantations: Although stents have not been shown to prevent heart attacks in patients in stable condition who have not suffered a heart attack, it is still a very popular procedure for these patients. In one instance described in the report, a patient in his early 60’s who was suffering from heart pain went to an emergency clinic and was told that he needed an invasive procedure—a coronary angiogram–to determine whether he needed a stent implantation to unclog an artery. The man had not suffered a heart attack, and his heart was functioning normally.
Rather than getting the procedure, the man sought out other opinions, only to learn that the data showed that stents for patients in stable condition do not prevent heart attacks nor do they extend the lives of patients. The safer and better treatment is a change in diet, weight loss and medication. But, hundreds of thousands of patients each year get stent implants, which are both unnecessary and can be a risky procedure.
And, lest you believe the stent implantation does no harm, the report describes how a man recovering from treatment for Hodgkin’s lymphoma who was suffering from shortness of breath, received a stent implant—presumably to address his shortness of breath–he did not need. Then, when he needed a life-saving lung transplant, he couldn’t get it because the medications he was taking for the stent implant would cause a dangerous interaction. Before he could get off those medications, he ended up dying.
The problem with atenolol, a beta blocker: After atenolol, a beta blocker, was found to lower blood pressure, it became a commonly prescribed medicine, particularly for older adults. What’s concerning is that after it was determined to not be effective in preventing heart attacks and stroke and in fact to increase the chances of stroke in older adults, it was prescribed to 2.6 million people with Medicare in 2014 alone. While each year fewer prescriptions for atenolol are written, the report indicates that it likely will be more than a decade before doctors stop prescribing it.
The problem with arthroscopic partial meniscectomies (APMs): Though physical therapy has been found to be the effective treatment for people with torn menisci, patients with meniscus tears too often receive unnecessary and unhelpful arthroscopic surgery to repair the tears.
What consumers can do: Because we have little or no medical expertise, questioning our doctors can be challenging. We may need to do our own research or to get a second or a third opinion. But, it can be well worth the time and effort.
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