The subject of unnecessary diagnostic testing is a contentious one that I’ve addressed here before (Overdiagnosis, Screening Tests). In human medicine, the government provides evidence-based guidelines for preventative healthcare interventions, including screening tests, through the U.S. Preventative Services Task Force (USPSTF). While being mostly ignored, this agency occasionally draws great controversy when challenging the classic American myths that More is Better and Statistics Don’t Matter. For example, after concluding that the evidence didn’t support routine screening mammography for as many women as had previously been told to have it done, the USPTF revised the screening guidelines. This generated a media conflagration on the scale of the Culture Wars, and led to a bunch of lawyers and politicians with remedial science knowledge passing legislation directing the government to ignore the evidence. Fortunately, other recommendations for less widespread screening for prostate cancer and cervical cancer have been greeted with less hysteria.
Still, the idea that unnecessary screening tests hurt more people than they help is a tough sell to those who don’t understand the complexities of reliability, validity, predictive value, and other factors involved in evaluating the risks and benefits of disease screening. Anecdotes about individuals who had a potentially serious disease detected by screening and believe that the subsequent treatment saved their lives are very compelling. They seem to get more coverage and have more impact than stories about people harmed by unnecessary treatment after detection of lesions that likely would never have caused them any problem. Nevertheless, unnecessary diagnostic tests not only cost a lot of money, reducing the resources available for providing necessary healthcare, but they also do harm many individual patients who are forced to go through unneeded secondary testing or treatment for diseases that either don’t exist or would never have made them ill.
A new organization of physicians has been formed to try and educate both clients and doctors about this problem and to make sound, evidence-based recommendations about diagnostic testing. Choosing Wisely has gotten a fair bit of media coverage lately for promoting lists of specific procedures that are often done unnecessarily, and for suggesting that these only be done when certain criteria are met. The lists also address some therapies which may be unnecessary, including the ever-popular excessive and inappropriate use of antibiotics.
These lists have generally avoided particularly controversial subjects, and so far haven’t been greeted with the panic that some of the USPSTF recommendations have. Hopefully, the effort will have some impact on physician behavior and consumer expectations. And once the organization and its approach is familiar and gains some credibility, perhaps they will be able to take on more controversial subjects, such as the lack of evidence to support annual physical examinations in adults without symptoms of illness (or even CAM therapies and tests not supported by evidence?).