You can never have too much of a good thing. Or can you? In Canada, we use public funds to pay for diagnostic tests, surgeries, and many medical treatments, so it’s natural to assume that more healthcare is better. The more you are tested, diagnosed, and treated, the healthier and longer you will live. No, not necessarily! Some medical tests and treatments can be a waste of valuable healthcare dollars and harm patients.
It is estimated that around $100 billion is wasted annually in the United States on unnecessary healthcare. This money could have been used to provide the healthcare that people really need. In addition, eliminating low-value diagnostic tests and treatments can reduce the carbon footprint of the healthcare sector and contribute to global warming.
“Substandard care” refers to tests and treatments that have no benefit to patients and may cause physical or psychological harm. They may take the form of blood tests, imaging, medications or surgical procedures. For example, X-rays or CT scans for low-risk back pain within the first six weeks of symptom onset do not change the patient’s treatment, as most back pain improves during this period. However, the patient is exposed to unnecessary radiation.
Antibiotics can save lives when used correctly, but they can cause unwanted side effects, serious complications, or even death in some people. Antibiotics do not work against viruses, the cause of all colds and flu infections, almost all sinus infections, and most cases of bronchitis. Therefore, the risks of antibiotics outweigh their benefits when used for most cases of stuffy nose, cough, or sinus pain.
Opioids are powerful painkillers and can help with severe pain immediately after surgery or cancer pain. However, they are not the best option for chronic pain associated with arthritis, back pain or migraines. Opioids can lead to addiction, withdrawal symptoms and side effects such as reduced alertness, nausea and constipation. Similarly, sleeping pills may be appropriate for a few days in acute sleep-deprived situations, but lose their effectiveness if taken for a longer period of time and can cause falls and cognitive decline in the elderly.
The media, medical establishment and cancer nonprofits have been pushing the message for years that cancer screening saves lives. But the reality is more nuanced. A recent study analyzing 18 studies with 2.1 million participants and examining six common cancer screening tests for breast, colon, lung and prostate cancer found that only one test – sigmoidoscopy for colon cancer – increased overall life expectancy, and by only 110 days. The other cancer screenings did not make people who underwent cancer screening live longer.
Patients and even some doctors assume that cancer screening is always beneficial and can do no harm. But we know that all medical tests, procedures and treatments have risks and benefits. Cancer screening can lead to false positives that require more invasive tests – such as biopsies, with bleeding and infection as possible complications. Screening can also lead to overdiagnosis and overtreatment – that is, unnecessary treatment for a disease that is not life-threatening or would never have caused symptoms. People who attend cancer screenings are at much higher risk of receiving a false positive, overdiagnosis or overtreatment than of having their life saved by the screening.
The decision to implement a screening programme is based on the benefit of lives saved at the population level, but the risks may not be acceptable at the individual level. For example, screening 1,000 women aged 50 to 69 for breast cancer with a mammogram every two years for seven years will save one life but result in three women being treated unnecessarily for breast cancer because we do not know which cancers will cause severe illness or death once diagnosed.
Does this mean that you should never get cancer screening? No, because some people benefit from early detection and treatment of cancer. It may even save your life. Therefore, people and their doctors need to make decisions together to discuss the risks and benefits of testing, the patient’s specific risk profile, and their values and preferences.
To maintain the sustainability of our health care system and ensure effective and medically necessary care, we must eliminate low-value treatments and redirect the resources available to high-quality health investments.
Investing in children’s health – whether in early childhood education, prenatal nutrition or childhood immunizations – pays dividends for population health across the lifespan. So does promoting healthy lifestyles and preventing diseases such as high blood pressure, diabetes and heart disease. Strengthening the social determinants of health by providing adequate income, quality education and adequate housing improves health in ways that many tests and treatments with little benefit do not. Let us choose wisely how we spend our health care dollars.
Vamini Selvanandan is a general practitioner and health practitioner in the Bow Valley. Her comments appear in the View of the Rocky Mountains on the third Thursday of every month. For more articles like this, visit www.engagedcitizen.ca.
