More Medicine Isn't Better Medicine

At first, two items that recently crossed my desk, separated by a couple of weeks, didn't seem to have anything in common except children—one was about antibiotics, the other about CT scans, both in a pediatric setting. But then I recognized their unintentional common theme: the consequences of overuse. The antibiotic item was in the September issue of the Journal of Family Practice. It described a study that showed a strong tie between antibiotics given to infants in their first year and the possibility that they would be diagnosed with asthma by age 7. The more antibiotics the babies got, the greater their chance of asthma down the road.

The CT report, in the September issue of Pediatrics, noted that these scans employ X-rays, even though the term isn't part of their name. X-rays are a known cancer risk, and a single CT scan exposes kids to a heavy dose—an abdominal scan showers a 5-year-old child with about 100 times the radiation dose of a conventional set of X-rays. Children are at greater risk than adults are from CT scans. Their developing tissues and organs are more sensitive to radiation, and unlike a 50-year-old adult, they have decades in which a cancer could bloom. The number of scans done on kids has been climbing fast—the authors estimate that about 1 in 9 CT scans is performed on a child—as physicians increasingly have come to rely on their findings and to use the scanners for more types of cases.

Maybe that's not the best idea, the authors suggest. In some situations, ultrasound or MRI, neither of which involves radiation, could be used instead. The amount of radiation in a CT scan can also be reduced, lowering the risk. Above all, there should be a solid reason to put a child into the CT scanner ring.

The difficulty with both of these articles is our embedded tendency to think that if a little care is good, more is better. Patients are susceptible to this for reasons as diverse as direct-to-consumer pharmaceutical advertising and the pedestal on which caregivers are placed, and many physicians are onboard because of pressure from patients, not-quite-baked studies, and the cold fact that the more intense the care, the higher their income. Shannon Brownlee spells it all out in an important new book (and in a conversation with my colleague Nancy Shute), Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, that deserves more attention than it is likely to get. Not many people eagerly crack open books about our healthcare system, even one that addresses fundamental flaws, of which the two papers that crossed my desk reflect small but telling examples.