We're so enthralled by technology we sometimes invest technical advances with attributes they do not deserve. The article in Reuters about CT scans for heart disease does a good job raising concerns about new recommendations. The new guidelines open the door to use this new technology in more cases, even when people have no symptoms.
Some experts are raising red flags:
"A test cannot predict whether or not you are going to have a heart attack, and it can't prevent getting one," [Dr. Rita F. Redberg, a cardiologist at the University of California, San Francisco, who was not involved in the work.] said. "You get more false information than you get real information."
She said she usually counsels patients mostly based on known risk factors such as diabetes and obesity. In those cases, she may prescribe drugs to lower blood pressure and cholesterol levels.
But first and foremost, she recommends eating a heart-healthy diet, getting regular exercise and not smoking.
"Those things will prevent you from having a heart attack," she told Reuters Health.
via www.reuters.com
and:
Dr. Patrick G. O'Malley, a general internist at the Uniformed Services University in Bethesda, Maryland, said the new criteria might increase overtesting.
"I think there is a risk that people will confuse appropriateness with evidence-based," he said. "In general, these kinds of criteria tend to get misinterpreted."
He said the writing group consisted of people with vested interests in the technology because they use it every day.
"They didn't include people who are not involved in this research," he told Reuters Health. "They didn't include a patient perspective."
People struggle with lifestyle recommendations, but rather than drop the ball and kick people over for a dose of xrays with questionable benefit, primary care practices can actually save lives through health coaching and motivational interviewing (techniques we used in the Ideal Medical Practices project based on Ahles et al*).
Of course it would help greatly if:
- Health payment policy didn't punish primary care for taking the time to help people with lifestyle change
- Health payment policy didn't richly reward 'just doing stuff' regardless of the overall benefits to patients and communities
All hand-wringing and tearing-of-hair over health spending aside our country continues to shell out big bucks for "pretty pictures" (Dr. Redberg's words) while the basic - and evidence based - work of effective primary care goes under- or un-funded and mostly neglected. This isn't 'penny wise and pound foolish' - it's just plain foolish.
*Ahles T, Wasson JH, Seville JL, Johnson DJ, Cole BF, Hanscom B, et al. A controlled trial of methods for managing pain with or without co-occurring, psychological problems. Annals of Family Medicine, 2006; 3, 1–13.
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