Pandora’s Box

If this was your knee, wouldn't you want an actual doctor looking at this x-ray?

If this film depicted your knee, I’d say it’s fair to assume you’d want a doctor to diagnose whatever problem you might be having with it. But if you were a patient x-rayed at one of several hospitals in the Southeastern U.S. from May 2007 through January 2008, there’s a good chance a non-doctor called a Radiology Practice Assistant looked at it instead.

To add insult to surgery (perhaps), the remote imaging company likely then sent it back (electronically) to where it was taken along with a diagnosis of your problem “written” by a “doctor” who actually never saw your film.  

This disturbing scenario – an electronically-enabled potential surgery factory faciliated by people without adequate medical training – is detailed in the recent indictment of Dr. Rajashakher P. Reddy, owner of Atlanta-based Reddy Solutions, according to the U.S. Department of Justice. 

What’s disturbing about it to me is the imaging aspect I’ve written about before on this blog (see “The Surgery Factory”, which discussed higher incidences of back surgery in areas with higher concentrations of MRI machines). Are we really taking so many images that it’s necessary to outsource radiology to private companies? And if that’s the case, are we really truly helping to heal these patients? 

I suspect not – instead we’re caving to special interests who advocate espensive medical imaging for everything for breast cancer screening for younger women (a very controversial subject right now) to people like me with regional back pain or sciatica who would likely benefit just as much from a conservative prescription of light exercise as they would from a laminectomy. (Don’t believe me? Check this study out.) 

Without delving too deeply into the breast cancer screening issue, I think it’s an instructive example that sheds light on the failure of back pain treatment in this country. 

To recap: the U.S. Preventive Services Task Force recently recommended that women in their 40s not get routine breast cancer screening – which goes against longstanding previous policy. The reason? Overall, it likely does more harm than good, leading to unnecessary anxiety or major surgery that may not be needed.

The imaging lobby – with the help of journalists who unfailingly painted sympathetic pictures of women saved by early detection – declared an absolute  jihad on the task force and anyone who dared to espouse its recommendation.

Gary Schwitzer, author of the excellent Schwitzer health news blog, called them out in this post , which detailed the inherent conflicts of interests of beneficiently-labeled groups like the American Cancer Society Cancer Action Network, (donors include Hologic, which makes breast imaging products, and Johnson and Johnson, maker of an image-guided breast biopsy product) and the American College of Radiology Imaging Network Fund for Imaging Innovation, whose donors include Siemens, GE Healthcare, Phillips, Hologic, and many others that make mammography machines or related products.

This experience is worth taking note of as the drive toward U.S. health care reform gathers momentum. It’s clear that vested interests like the medical imaging lobby and Big Pharma will fight like hell to keep Pandora’s Box open, even if it means patients suffer as a result.


2 responses to “Pandora’s Box

  1. Same thing with prostate cancer too, basically. I think what’s hard for people swallow is the notion that sometimes, it’s better to not know, to protect ourselves–from ourselves. It’s weird, if you think about it.

    • That’s true Matt, good point. I think for the most part surgeons earnestly believe they’re helping their patients but the truth is they’re trained to cut and that’s what they end up doing most of the time – after all, if you’re a hammer, everything looks like a nail, right? Here’s another conundrum that I’ll blog about later: There are precious few randomized clinical trials (the gold standard of medical research) comparing the efficacy of surgery to non-surgical options. In some cases, the medical community doesn’t feel comfortable conducting these trials because they would require basically staging fake operations that would help to measure the placebo effect. What’s ironic is that so much surgery is conducted despite the fact that many procedures have been validated only through less-effective observational studies – where are the ethics in that?

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