10 Overused Tests and Treatments
Consumer Reports
November 2007 - Page 13

1. Back Surgery
Don't rush to surgery for a simple slipped disk. In 90% of cases, the pain goes away on its own within six weeks. In stubborn cases, surgery, which can cost $20,000 plus physician fees, can relieve pain somewhat faster than physical therapy and medication, a recent study showed. But it also found that both groups of patients wound up with similar improvements after two years.

2. Heartburn Surgery
Doctors surgically tighten a sphincter muscle that blocks stomach acid from backing up into the esophagus. But research shows the operation, which costs $14,600 or more, provides no better long-term relief than taking a proton-pump-inhibitor drug such as omeprazole (Prilosec OTC), which costs less than $1 a day.

3. Prostate Treatments
Prostate cancer is often over treated by surgery that costs $17,000 or by radiation therapy for $20,700 or more, plus physician's fees, without adequate discussion of the alternatives or the high risk of distressing side effects such as incontinence or impotence. Because prostate cancer can grow slowly, sometimes the best approach is "watchful waiting."

4. Implanted Defibrillators
These devices, which automatically shock the heart back to normal rhythm, cost some $90,000 over a lifetime. Yet one-third of people who get them might not really need them, according to research report in 2007. This year Medicare will pay for an estimated 50,000 of the devices.

5. Coronary Stents
Billions are spent each year inserting tiny mesh tubes to prop open coronary arteries. The procedure plus heart drugs turns out not to work any better to prevent future heart attacks than heart drugs alone for patients with stable coronary artery disease, researchers reported in 2007.

6. Cesarean Sections
They cost almost $7,000, about 55% more than a natural delivery, and constituted a record high of 30.2% of births in 2005. Most are performed because labor is progressing too slowly. But several less-invasive approaches might be enough to speed up labor.

7. Whole-Body Screens
These CT scans, which can cost $1,000 or more, are promoted for spotting early signs of cancer, heart disease, and other abnormalities. There are no proven benefits for healthy people, the Food and Drug Administration has concluded. Plus CT scans expose patients to far more radiation than X-rays. A few CT scans a year can increase your lifetime risk of cancer.

8. High-Tech Angiography
Using a CT scan to noninvasively check coronary arteries for narrowing costs an average of $450, according to data from HealthMarkets, which sells health and life insurance through subsidiaries in 44 states. But standard angiography is sometimes still needed to confirm blockages that might require aggressive treatment.

9. High-Tech Mammography
Using software to flag suspicious breast X-rays would add $550 million a year to national costs if used for all mammograms. But a 2007 study found that this technique failed to improve the cancer-detection rate significantly, yet resulted in more needless biopsies.

10. Virtual Colonoscopy
These CT scans are being used to detect signs of cancer without inserting a tube into the colon. But a study of virtual colonoscopy reported in 2007 concluded that standard colonoscopy is better at spotting smaller suspicious polyps. Though less costly than a standard colonoscopy, the virtual test isn't cost-effective because any suspicious finding requires retesting with the real thing.