Feb. 17, 2010 -- More drugs, more tests, more surgery.
A report by the U.S. Centers for Disease Control and Prevention shows that the use of high-tech medical tests and surgeries has escalated rapidly over the past decade in the United States. But whether the expanding presence of medical technology is a good thing is still a matter of debate.
The rates of Americans getting MRIs and CT scans tripled between 1996 and 2006, according to the report released today from the National Center for Health Statistics. CT scans can help doctors detect everything from kidney stones to cancer, but they pack a mega dose of radiation -- as much as 500 times that of a conventional X-ray, which some health experts say raises the risk for cancer.
More Americans are also going under the knife. According to the report, the rate of knee replacement procedures increased 70 percent over the decade studied; kidney and liver transplants increased by 31 percent and 43 percent, respectively.
What's more, Americans are also on more drugs now than in years past: 47 percent of the population in 2006 was taking at least one prescription drug, compared to 38 percent in 1994. About one in five Americans in 2006 were taking three or more prescriptions -- nearly double that in 1994.
Of course, increased use of new medical technology and a spike in the use of prescription drugs has occurred alongside a continual increase in life expectancy and decrease in death rates for cancer, heart disease, and stroke. The connection between these two trends remains unclear, however, experts say.
Spike in Med Tech, Dip in Disease
Still, considering the overall rise in life expectancy, some doctors say Americans are more healthy for the increase in medical interventions.
"Death rates are down for things like heart disease and stroke, which I would suspect has to do with better diagnosis [through diagnostic imaging technology] and people going on preventive medications like statins," says Dr. Daniel Kopans, director of the Breast Imaging Division at Massachusetts General Hospital. The CDC found a ten-fold increase in the use of statin drugs from 1988-1994 to 2003-2006.
But according to Dr. Nortin Hadler, professor of Medicine and Microbiology/Immunology and the University of North Carolina at Chapel Hill and author of "Worried Sick" and "The Last Well Person," "We may be fooling ourselves as a society" in thinking that all this technology is actually making us live longer.
"The decrease in premature death can be traced back long before we had many important interventions," Hadler says. "[It is] not clear that all of our high-tech knowledge is responsible for this. ... The data is consistent that if we never perform a single stent or angioplasty, we would not change the happy outcome of fewer people having and/or dying from heart attacks."
Still, he says, most in the public assume that the high-tech interventions are responsible, which drives up demand.
"Our society has learned that we are technologically dependent for our longevity. So you put together this notion that without all the high-tech we would all be in big trouble and the fact that advantaged areas of society are living longer and you have a perfect marketing storm," he says.
"We are by far the most over-treated, over-medicalized people in the history of the world," he says.
Misuse, or Miracle-Maker?
That Americans are over-treated has become a common claim in light of sky-rocketing health-care costs, but diagnostic experts dispute Hadler's argument that our advanced technology is not actually improving health care.
"I know what healthcare was like in the '60s and '70s," says Dr. Herb Kressel, radiologist-in-chief at Beth Israel Deaconess Medical Center in Boston. "There's no doubt in my mind that we're doing a better job ... no doubt that in part [the decrease in mortality] is due to technology. The problem is how we use the resources effectively to prolong life and improve quality of life."
Kopans cites unexplained abdominal pain as an example: In the 1960s, exploratory surgery often would be used to diagnose the problem -- a painful and somewhat risky process that today is done easily and painlessly with CT scans and ultrasound. And he says that technological advances have had similar benefits for breast biopsies; whereas invasive surgery was once needed, now ultrasounds allow the biopsy to be done with needles.
Both Kopans and Kressel agree that overuse of these technologies -- especially diagnostic or screening tests -- is a problem. But they say it is not one that should be solved by using less technology across the board, but rather by using technology selectively, where it is needed, and where it can do the most good.
A substantial part of over-utilization of this technology is "reflecting defensive medicine," Kressel says, where doctors fear that if they don't provide every test, than they will be liable when they miss a diagnosis.
"The trick is we really need research to know how to use these tools in a manner that will be preventive and predictive, to tailor the tests and interventions to what the patient really needs," Kressel says.
And this may be where the two sides meet. Hadler says that when this new technology is used for a specific diagnostic purpose, that is likely to provide insight into healing.
"Now that's a medical advance," Hadler says.