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Can Advances in Medical Technology Make Us Less Healthy?

Sometimes the treatment is riskier than the disease...

by
Theodore Dalrymple

Bio

July 9, 2013 - 4:00 pm
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There is more rejoicing in the chambers of malpractice lawyers over one missed diagnosis than over ninety-nine dangerous, unnecessary and expensive investigations. It is therefore unsurprising that doctors are particularly anxious not to miss pulmonary embolus, a clot in the pulmonary arteries, which has been called a silent killer. There are several factors that predispose to PE, as it is known, among them age, a recent operation or having sat for a long time in a confined space. A friend of mine collapsed with a PE at home one day, and it was then that his polycythaemia rubra vera, a chronic overproduction of red cells, was diagnosed.

If PE can kill you, and if there is an effective treatment, it might seem that an improvement in the ability to detect it is to be welcomed. But, as is often the case in medicine, matters are a little more complex than they seem. As a recent article in the British Medical Journal put it:

If all pulmonary emboli caused important harm or death if untreated, finding more small clots would be an unqualified advance. However, there is evidence that some small clots do not need treatment…

And while new technology allows more small clots to be detected that would not have been detected by older methods, it does not give any guidance as to which of them should be treated. Since treatment (with anticoagulants) is itself not without risk, it is possible that the increased detection of small clots does more harm than good.

In the 8 years after the introduction of a new technique called multidetector CT pulmonary angiography, the rate of pulmonary embolus in the U.S. rose by 80 percent, from 62.1 to 112.3 per 100,000 adults. Part of the problem was that the new equipment, being very expensive to install, had to be used to justify its purchase. The result was many more PEs.

Treatment made no great advances in those years, and the overall rate of death from PE in the United States remained more of less constant. However, the fatality rate of detected PEs fell greatly, from 12.3 to 7.8 percent, suggesting that most of the PEs that were now being detected that would not previously have been detected were harmless.

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All Comments   (6)
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we should put more effort and investments in medical research nothing great have been achieved in recent years, rather more disease and infections spread.
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39 weeks ago
39 weeks ago Link To Comment
"Treatment made no great advances in those years, and the overall rate of death from PE in the United States remained more of less constant. However, the fatality rate of detected PEs fell greatly, from 12.3 to 7.8 percent, suggesting that most of the PEs that were now being detected that would not previously have been detected were harmless.""


That statement is baffling in its illogic. Earlier detection, absent any improvement in treatment techniques, leads to FEWER fatalities, and from that you conclude "that most of the PEs that were now being detected that would not previously have been detected were harmless."????

Either you just fumbled the construction of the paragraph, and are NOT saying what you seem to be saying, or you have no business writing on any subject in this field.
39 weeks ago
39 weeks ago Link To Comment
it could be both
39 weeks ago
39 weeks ago Link To Comment
ITs up to our lawmakers and us voters to see that the lawyers don't take over, whether in the form of scaring docs in to massive overkill (aghhh) in using diagnostic whats-its OR in the form of the massive government intrusion. (O-Care.) Tort reform where doctors would only have to fear lawyers if they were absolutely incompetent, neglectful or malicious would work. In the continually changing saga of O-Care, we have forgotten the litany of conservative solutions: tort reform, transportability of insurance, health insurance companies allowed to function across state lines, allow free-market forces to lower costs... and a few others that I have forgotten. Oh well. One day the adults will come back home and throw all these partying idiot fools out.
40 weeks ago
40 weeks ago Link To Comment
we certainly wouldn't want to try to improve anything. life was so much better when we didn't have pacemakers, joint replacements and antibiotics.

now we can detect subclinical disease. we wouldn't want that. and, since we currently know everything that there is in the universe to know, there is no chance that the future might bring new interpretations.

best that we cringe before the lawyers and go back to leeches, cupping and bleeding with a good dose of physic. yep, that's the ticket.
40 weeks ago
40 weeks ago Link To Comment
Us Biomedical Engineers simply invent the stuff. It's up to you Physicians to use it appropriately.
40 weeks ago
40 weeks ago Link To Comment
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