medcial doctors overuse mri’s — part i

TOO MANY MRI’S & CT SCANS? 
THE EVIDENCE SAYS “WAY TOO MANY”

(Especially if the Doctor owns the Imaging Facility!)
MRI overuse

Photo by Tomáš Vendiš

What does the average patient think they know about MRI’s & CT Scans?  They know what they have heard parroted by the medical community.  When X-rays don’t show the reason for your pain, you should have an MRI or CT, because these advanced imaging techniques show eeeeeeeevvvvverything!  But is this really true? Not only is it not true, but it has been one of the better-kept dirty little secrets of medicine for the past couple of decades.

To begin to understand this whole phenomenon, let’s look for a moment at what Neurologist, Dr. J Kassicieh said in a recent article he wrote concerning a study published in the prestigious New England Journal of Medicine —- nearly 20 years ago:

For patients that do get MRI studies, it is not uncommon to find spine MRI abnormalities. The important fact is that these abnormal MRI findings do not necessarily explain the pain that that individual is experiencing. To account for an individual’s back pain or sciatica (leg pain), the MRI findings must correlate exactly with the patient’s symptoms and neurological exam to have clinical significance.   MRI studies of normal individuals without back pain or sciatica have been done. The results have shown that approximately 55% had bulging discs at one or more levels, 28% had disc herniation on the MRI scans. More than 70% of the MRI scans showed abnormalities and yet the patients had no symptoms!
These MRI scans were done on patients who never had any back or leg pain – 70% of the MRIs were “abnormal.” The conclusion that just because the MRI scan shows “something”, does not mean that the findings are the cause of any given patient’s back or leg pain. (These are known as ASYMPTOMATIC DISC BULGES)

In other words, well over 50% of the adult American population is walking around with disc bulges in their spines —- and they do not even have any idea, because they have no pain.  This research has been verified in the peer-reviewed literature many times over. 

In a paper that was E-published in the October 31, 2011 issue of Orthopedic Sports Physical Therapy, it was stated that, “It [MRI & CT] may not be able to pinpoint the specific source of your pain…..  Increased use of unnecessary imaging may lead to less than favorable results.”  This begs the question of exactly what is meant by the term, “less than favorable results“?  If you have a test done that tells you that you have a problem, but you really do not have the problem they say you have; this is called a false positive.  False positives lead to dangerous treatments that are completely unneeded. 

A perfect example of this phenomenon was dealt with in a recent editorial by renowned surgeon, Dr. Malcom Kell, in the British Medical Journal, concerning advanced diagnostic imaging for breast cancer.   “Magnetic resonance imaging (MRI) scans of the breasts are so sensitive that they detect large numbers of non-cancerous tumors and lead to unnecessary breast removal surgeries“.  When you have a surgeon editorializing this problem in one of the most prestigious medical journals on the planet, you know that the problem is significant (current research says that greater than one in ten breast MRI’s produce false positives). 

Earlier this month, Johns Hopkins University Medical School jumped into the fray with a press release titled, Costly Diagnostic MRI Tests Unnecessary for Many Back Pain Patients. The most prestigious medical institution on the planet verified what I have been telling you —– that routine MRI imaging does not improve treatment outcomes and does not play a role in a physician’s decision to give epidural steroid injections, the most common procedure performed at pain clinics in the U.S.  “Our results suggest that MRI is unlikely to avert a procedure, diminish complications or improve outcomes,” said study leader Steven P. Cohen, M.D., an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine.  But unfortunately, the problem is not confined to backs and BREASTS.

One of the world’s most well known sports medicine orthopedic surgeons (Dr. James Andrews) wanted to test his suspicion that shoulder M.R.I.s might not be telling the whole story.   He scanned the shoulders of 31 perfectly healthy professional baseball pitchers — players with no pain and no throwing problems.  What did he find?  He found abnormal shoulder cartilage in 90 percent of these players and abnormal rotator cuff tendons in 87 percent of them. What was his conclusion?  “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.”  This is exactly what I have been telling people for well over a decade.  Just go DESTROY CHRONIC PAIN, and look at our pages on SHOULDER TENDINOSIS, and ROTATOR CUFF PROBLEMS

When I went to a recent seminar in Chicago put on by Dr. Jay Kennedy, he verified all of this using numerous scientific studies fro the past 15 or so years.  The conclusion of the medical community is that MRI & CT do not do what the general public has been led to believe that they do!  So, why does the charade continue.  It has always been my opinion that it has to do with a five letter word that starts with “M” —- MONEY.  Biiiiiiiiig money!

Four years ago, experts in the Insurance Industry stated that unnecessary CT and MRI scans were costing them roughly $30 billion a year.  Just like the problem with PRESCRIBING ANTIBIOTICS for seemingly everything under the sun despite huge amounts of research to the contrary (HERE), the problem of over-utilizing advanced imaging techniques has not improved.  This is not just an issue of practicing “Defensive Medicine” (as stated by Dr. Lundberg above).  This is an issue of using technologically advanced imaging as a revenue stream (it’s actually more like a revenue river).

These scans cost roughly $2,000 a pop and, at least in the case of CT scans (computerized tomography), can subject patients to serious levels of radiation (Google “CT RADIATION“). But they’re giant moneymakers for hospitals and specialty clinics, which often heavily advertise the high-tech scanners in order to cultivate a “state-of-the-art” image among potential patients. Of course, the machines are also expensive, which creates incentives for doctors to use them as frequently as possible, and then stick insurers or the federal government with the bill.

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