It’s been almost 20 years now since I tore some of the meniscus in my right knee playing basketball. And, because I was stubbornly bent on proving I could continue embarrassing myself on the court into my 50s, I elected to undergo arthroscopic surgery to shave away the ragged tissue. The procedure was uncomplicated (though watching my meniscus disappear on a video screen was a bit surreal) and the results satisfactory, but it seems now that it was completely unnecessary.
A University of Maryland study published earlier this month in JAMA Internal Medicine listed meniscal cartilage surgery as one of the 10 most worthless procedures and tests perpetrated on the American public in 2016. “Having surgery for a meniscus tear did not improve symptoms, even for patients who had clicking in the knee,” researchers reported. “Because of fewer risks and lower costs, conservative management and rehabilitation are a more effective strategy.”
Geezers are more susceptible than most to these sorts of interventions, given our general immersion in the Medical-Pharmaceutical Complex, so it was heartening to see the list making the rounds in the industry press — even though most of the procedures listed require some level of translation. If your doctor recommends transesophageal echocardiography to see what shape your heart is in, for example, you might want to know that he’s going to run a tube with a transducer down your throat to a place behind your heart, where it will produce an ultrasound image. You also may want to know that it’s no more effective — and much riskier — than less-invasive diagnostic procedures.
Researchers found similar cost/benefit gaps with computed tomography pulmonary angiography and computed tomography in patients with respiratory symptoms, both of which expose unwitting victims to unnecessary levels of radiation. The use of advanced cardiac imaging, they noted, has more than tripled over the last decade and often leads to “unnecessary hospitalization and intervention.”
Then there’s the popular carotid artery ultrasonography and stenting, an intervention designed to widen plaque-laden arteries that doctors tend to favor far more often than is advisable. “This study found that more than 90 percent of carotid ultrasonography for patients with symptoms, who end up having stents or surgery, is performed for uncertain or inappropriate indications,” the authors reported.
The rest of the list may be more familiar to those who have been paying attention to these issues in recent years:
- Aggressive management of prostate cancer. “The researchers argue that blood tests for prostate cancer should generally be avoided because they are more harmful than beneficial.”
- Overuse of antibiotics. “Up to half of all antibiotic use is inappropriate, exposing patients to the risk of adverse drug events, and increasing the overall risk of resistant bacteria.”
- Supplemental oxygen for COPD patients with a moderate lack of oxygen. “Giving extra oxygen to patients with the lung illness chronic obstructive pulmonary disease, who had only mild oxygen deficit, did not improve quality of life or lung function.”
- Nutritional support in medical inpatients. “Giving critically ill patients nutritional interventions, generally oral feeding, made no difference in overall death rate or length of stay in the hospital.”
The U of Maryland report arrives five years after the ABIM Foundation, working with dozens of mainstream medical organizations, launched the “Choosing Wisely” initiative, designed to reduce unnecessary medical procedures. So, I suppose it’s fair to note that there are still a few physicians who have not yet heeded the call.
And, in fact, that’s just what University of Michigan researchers reported last week when they released their evaluation of the five-year campaign. The list of things your doctor should not do to you has now “snowballed” to include more than 500 procedures — everything from specific uses of blood tests and scans to certain drugs and medical gadgets. As a statement released by the university put it, “Behind each one lies a body of evidence showing that it’s not necessary for specific patients — or that it may even harm them.”
Not surprisingly, it seems the problem involves ingrained attitudes across the entire healthcare industry. “Changing the behavior of patients, providers, and health systems is not easy,” explains study coauthor Sameer Saini, MD, MS. “We need to be more thoughtful about how we design programs and interventions to reduce the use of low-value care and be more rigorous and complete in how we assess whether these programs actually worked.”
Saini and his colleagues tiptoe around what is fairly obvious to this healthcare skeptic: Medical procedures equal revenue. The more you do, the more you earn. But you can also trace this interventionist obsession to the saturation marketing of pills and procedures to a receptive population of anxious healthcare consumers, the majority of whom tend to view their doctors as all-knowing demigods.
I never questioned my doctor’s advice to dig out the detritus from my knee back in 1998. And I suppose you could say the surgery worked, since it enabled me to get back onto the court the following season and humiliate myself into my early 50s, but it’s not the route I’d take if my other knee should fall apart. Fortunately, that’s kind of a longshot, since I haven’t set foot on a basketball court in several years. The most legwork I get these days is pushing my grandson in his stroller, which is a necessary procedure if I want him to take a nap.