Cartoons for the holidays II

"I have no objection to alternative medicine so long as traditional medical fees are scrupulously maintained."

"Well,  Bob, it looks like a paper cut, but just to be sure let's do lots of tests."

"That would be in Aisle Six, the worried well section."

Cartoons for the holidays I

On my refrigerator:

"Let's see, where should Jerry hurt today?" 

"I ate all the wrong things today."

"I recommend using your third wish to prevent joint pain in later years."

Imaging overuse

A consortium of professional medical societies, including the American Society of Radiology, is fighting the overuse of imaging. Examples include scans for uncomplicated headaches, routine chest X-rays, and nonspecific back pain. Between 2000 and 2007, the use of imaging studies grew faster than that of any other physician service in the Medicare population. One study determined that 20 to 50 percent of imaging provides no useful information. The problem with too much imaging (besides unnecessary costs) is that it can expose you to excessive radiation and can lead to over-diagnosis followed by unnecessary interventions that do more harm than good.

Here’s a rundown of various types of imaging tests:

• X-ray: quick and cheap; low radiation; usually the best way to assess injuries to arms and legs. Radiation exposure is the same as three hours of environmental radiation to which we’re all continuously exposed.
• CAT scan, or CT: a computerized composite of hundreds of X-rays; provides more detail than an X-ray. For example, it can detect an intercranial hemorrhage. The radiation dose is about the same as eight months of background radiation.
  
• MRI: provides excellent detail and doesn’t involve radiation; uses a magnetic field and radio waves. Good for assessing soft tissues of joints and detecting subtle brain abnormalities, but not good for visualizing air-filled structures, such as the lungs. (It’s best for chronic headaches, but the CT scan is best of sudden and/or severe headaches.) The tube-like MRI and CAT scan devices look similar.
• Ultrasound: does not entail radiation; uses high frequency sound waves; scanner is hand-held “wand;” used for imaging pregnancies and fluid-filled organs such as the heart and gall bladder.

I have started to decline x-rays on my teeth, mostly because they strike me as an unnecessary expense. Of course, this decision does not go unchallenged. But I’m sticking to my guns.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

How to monetize your thermometer

We have an old-fashioned thermometer—the glass kind with a bead of mercury in it. I think we’ve had it for nearly 60 years. To use it, you must first shake it to be sure the mercury is below a normal temperature, then you stick it under the tongue for… I forget how many minutes. It’s hard to read. You have to angle it just right to see the line of mercury and read the tiny numbers that indicate temperature. We probably haven’t used it in 40 years so we never considered buying a new one. But the new ones are a great improvement. Easy to use and see the results!

But now I think they’ve gone too far with thermometer technology. There’s a company called Kinsa that makes a fancy thermometer. It syncs up with a smartphone app that allows you to track your fever and symptoms. So far, it’s in use in 500,000 American households, and the company was only founded in 2012! Not only is this thermometer digitized and interconnected with electronic devices, the data it collects can be used by other companies for targeting ads.

For example, Clorox has paid Kinsa to use the information collected by thermometers to target ads for Clorox disinfectant wipes. Because the data includes zip codes of the thermometer users, Clorox can direct more of its ads to the areas that appear to be experiencing a rise in cold or flu symptoms, as indicated by temperature spikes. Similarly, other companies can start targeting ads for cough drops or chicken soup or whatever. Company spokespeople assert that they’re helping prevent the spread of illness through early detection. Right.

My old-fashioned thermometer now looks rather appealing.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

To stent or not to stent

My husband recently had a couple of stents inserted into his arteries. He’d been having occasional chest pain (angina) when on the treadmill. A stress test and angiogram indicated some blockage, so he was scheduled for an outpatient angioplasty (inserting and inflating a tiny balloon to widen the artery). Instead, when the procedure was underway, the doc decided to insert a couple of stents (tiny metal cages) into his arteries. He ended up staying overnight in the hospital. The stents may have been unnecessary—but nobody asked me.

In a study last year of 200 patients, all of whom had one profoundly blocked coronary artery and severe chest pain, half the patients received stents and the other half received a sham operation. Both groups received medications, such as for high blood pressure. The result: those who got the sham procedure did just as well as those who got the stents. In an editorial published in Lancet along with the study results, Dr. Rita A. Redberg, of the University of California, San Francisco, commented that stents should be used only for people who are having heart attacks. Other doctors agree. (There’s general agreement that stents can be lifesaving for patients in throes of a heart attack. In 2002, my husband had a stent implanted under this circumstance.)

Stents have long been controversial. A 2007 study of 2,300 patients with symptoms of clogged arteries showed that stents did not prevent heart attacks or deaths from heart disease. In this study, all the patients had a relatively stable form of coronary artery disease that generally progresses slowly—the situation with most Americans who receive stents. Similar studies have consistently shown that stents have no advantages over a medications-only regimen. Ditto angioplasty. (Stents generate nearly $3 billion a year in sales in the United States for Boston Scientific and Johnson & Johnson, the two companies that dominate the market. Inserting them costs from $11,00 to $41,000. Husband's bill was $105K.)

My husband is now treading without pain. Still, if/when I’m in his shoes, I’m going to say no to stenting. At least that’s my plan.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.