Can Too Much Information Harm Patients? [Excerpt]

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http://www.scientificamerican.com/article.cfm?id=can-too-much-information

In his new book, cardiologist Eric Topol explores the ways in which the digital age is transforming medicine

Nearly 7 Billion people on the planet

Over 3 million doctors

Tens of thousands of hospitals

6000 prescription medicines, 4000 procedures and operations

Countless supplements, herbs, alternative treatments

Who gets what, when, where, why and how?

When a 58 year old, active, lean, intelligent financier from Florida came to see me for a second opinion, I should not have been surprised. For Valentine's Day the prior year, his wife's present was a computed tomography (CT) scan for his heart. She heard about it on the radio and also saw heart scan billboards on the highway. There was even a special deal of $100 off for Valentine's.

But her husband didn't have any symptoms of heart disease, didn't take any medications, and played at least two rounds of golf a week. On the other days, he worked out on an elliptical machine for 30 to 40 minutes. Until he got the heart scan.

My patient was told that he had a score of 710—a high calcium score—and his physician had told him that he would need to undergo a coronary angiogram, a roadmap movie of the coronary anatomy, as soon as possible. He did that and was found to have several blockages in two of the three arteries serving his heart. His cardiologists in Florida immediately put in five stents (even though no stress-test or other symptoms had suggested they were necessary), and put him on a regimen of Lipitor, a beta-blocker, aspirin and Plavix.

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1. the problem is not "too much" but "too little" info. or, "a little learning is a dang'rous thing"

if you do enough tests on anyone, you'll find something that the modern medical profession is trained to think needs addressing.
but everyone has "idiopathic" conditions, such as tiny benign tumors that aren't affecting anything of consequence.

and everything has risks, that tiny tumor is a risk, as it could become a problem. but any medication or procedure has its risks as well.

in this case, telling someone they have poor test results that could indicate a problem needs to be balanced out without apparently fully informing him about the undesirable side effects of the stent procedures and medications, or without running further tests or getting second or third opinion is a case of not enough information rather than too much information.

[cbayer]

2. Absolutely.

As in any business, there are people out there to sell a product and make a profit.

These *tests and labs* facilities are just that. They advertise completely unnecessary tests and labs. Then, when the patient takes the results to their doctor, the physician is backed into a corner. S/he didn't order it, but now knows about it and has liability. It's a bunch of BS.

If you look hard enough, you will find something wrong with everybody. It could be important or it could be transient, but you will find something.

[Ron Obvious]

3. Problems with the fees for service model.

A large part of the problem is the whole 'fee for service' model of American healthcare. Add marketing appealing to people's fears, and the huge liability industry and you have a formula for disaster. Telling your patients not to worry, lose a few pounds, and take some more exercise doesn't make anybody any money and opens up the doctor to liability. Large batteries of expensive tests and prescription drugs address both of those concerns, so that's what we're getting.

Also, add "Medicine by Numbers". Any number on any test that's not within the standard range should be brought up or down into the standard range, even though a lot of those number ranges (for e.g. blood pressure, blood sugar and cholesterol) have recently been narrowed for no apparent medical reasons. I hear some doctors want to add statins to our drinking water. Sounds insane to me.

My wife's doctor wanted her on blood pressure medications after a couple of readings around 135, which wasn't considered high before. Besides, she got these readings after being stressed through arriving at the doctor's office during rush hour traffic and walking up 4 flights of stairs. We pushed back and got a home monitoring set on which she records readings of around 118. Had we not done so, she'd have been on blood pressure pills for life, I suspect. As it is, the doctor insists on annual checkups for her which costs us approx. $900 out of pocket, and for which there is also little evidence that they're needed. We have (expensive, private) insurance, but we have to pay out of pocket for every prescription and doctor's visit.

I rather enjoyed reading the book Overdiagnosed last year. In fairness, that book simply confirmed my suspicions and I don't know if it's been accurately refuted by the medical profession.