"Millions of Americans
are increasingly realizing that when it comes to health
care, more is not necessarily better," said Dr.
Christine Cassel,¬ president of the
"Through these lists of tests and
procedures, we hope to encourage conversations between
physicians and patients about what care they truly
United States specialty societies representing more than
500,000 physicians developed lists of Five Things
Physicians and Patients Should Question in
recognition of the importance of physician and patient
conversations to improve care and eliminate unnecessary
tests and procedures.
See the full list
12 MEDICAL TESTS TO AVOID
1. Avoid Inducing Labor or C-Section Before 39 Weeks
Delivery prior to 39 weeks is associated with
increased risk of learning disabilities, respiratory
problems and other potential risks.
induction prior to 39 weeks is medically necessary,
the recommendation is clear that simply having a
mature fetal lung test, in the absence of
appropriate clinical criteria, is not an indication
College of Obstetricians and Gynecologists; American
Academy of Family Physicians)
Routine Annual Pap Tests
In average-risk women, routine annual Pap tests
(cervical cytology screenings) offer no advantage.
(American College of
Obstetricians and Gynecologists)
CT Scans to Evaluate Minor Head Injuries
Approximately 50 percent of children who visit
hospital emergency departments with head injuries
are given a CT scan.
CT scanning is associated with
radiation exposure that may escalate future cancer
risk. CT technology exposes patients to
approximately 100 times the radiation of a standard
chest X-ray which itself increases the risk of
The recommendation calls for clinical
observation prior to making a decision about needing
(American Academy of Pediatrics)
4. Avoid Stress Tests Using
The recommendation states that there is
very little information on the benefit of using
stress echocardiography in asymptomatic individuals
for the purposes of cardiovascular risk assessment,
as a stand-alone test or in addition to conventional
Society of Echocardiography)
Prescribing Type 2 Diabetes Medication to Achieve
Tight Glycemic Control
states that there is no evidence that using medicine
to tightly control blood sugar in older diabetics is
beneficial. In fact, using medications to strictly
achieve low blood sugar levels is associated with
harms, including higher mortality rates.
(American Geriatrics Society)
EEGs (electroencephalography) on Patients With
Recurrent headache is the most common pain problem,
affecting up to 20 percent of people. The
recommendation states that EEG has no advantage over
clinical evaluation in diagnosing headache, does not
improve outcomes, and increases costs.
(American Academy of Neurology)
Routinely Treating Acid Reflux
which is commonly prescribed in adults, has no
demonstrated effect in reducing the symptoms of
gastroesophageal reflux disease (GERD) in infants,
and there is emerging evidence that it may in fact
be harmful in certain situations.
ADDITIONAL MEDICAL TESTS TO BE AVOIDED
8. Avoid Lipid Profile
test checks various parameters of blood, such as
cholesterol (good or high density lipoprotein as
well as bad or low density lipoprotein) and
Several scientific papers have
people with high so-called "bad" LDL cholesterol
live the longest and there is noow a large
number of findings that contradict the lipid
hypothesis that cholesterol has to be lowered at
9. Avoid Mammograms
Mammograms and breast screening have had
no impact on breast cancer deaths and
have actually been found to
increase breast cancer mortality.
radiation, mammogram testing compresses sensitive
breast tissue causing pain and possible tissue
damage. To make matters worse, the false negative
and false positive rates of mammography are a
troubling 30% and 89% respectively.
is that many breast cancers occur below the armpits;
however, mammography completely misses this axiliary
region, viewing only the breast tissue compressed
between two plates of glass.
drawbacks, breast thermography should be given
Thermography is a non-invasive
and non-toxic technique which can detect
abnormalities before the onset of a malignancy, and
as early as ten years before being recognized by
This makes it much safer and
potentially life-saving health test for women who
are unknowingly developing abnormalities, as it can
take several years for a cancerous tumor to develop
and be detected by a mammogram.
10. Avoid PSA Testing
A PSA blood test looks for prostate-specific
antigen, a protein produced by the prostate gland.
High levels are supposedly associated with prostate
cancer. The problem is that the association isn't
always correct, and when it is, the prostate cancer
isn't necessarily deadly. Nearly 20 percent of men
will be diagnosed with prostate cancer, which sounds
scary, but only about 3 percent of all men die from
The PSA test usually leads to overdiagnosis -
biopsies and treatment in which the side effects are
impotence and incontinence.
Moreover, there is some
evidence which suggests that
biopsies and treatment
actually aggravate prostate cancer. During a needle
biopsy, a tumor may need to be punctured several
times to retrieve an amount of tissue that's
adequate enough to be screened.
It is believed that
this repeated penetration may spread cancer cells
into the track formed by the needle, or by spilling
cancerous cells directly into the bloodstream or lympathic system.
11. Avoid Routine Colorectal Cancer Screening
Colorectal cancer screening often results in
unnecessary removal of benign polyps which
are of no threat to patients and the risks of their
treatment or removal far exceed any benefit.
evidence is insufficient to assess the benefits and
harms of computed tomographic colonography and fecal
DNA testing as screening modalities for colorectal
12. Avoid DEXA
Dual energy X-ray absorptiometry (DEXA or DXA) in a
technique developed in the 1980s that measures,
among many things, bone mineral density.
can determine bone strength and signs of osteopenia,
a possible precursor to osteoporosis. Limitations
abound, though. Measurements vary from scan to scan
of the same person, as well as from machine to
DEXA doesn't capture the
collagen-to-mineral ratio, which is more predictive
of bone strength than just mineral density.
higher bone mineral density doesn't necessarily mean
stronger bones, for someone with more bone mass will
have more minerals but could have weaker bones.
Meanwhile, the ABIM effort
is gaining momentum and more financial support from key
The Robert Wood Johnson Foundation announced it has
awarded $2.5 million to,
"fund medical specialty
societies and regional health improvement
collaboratives to work in specific communities to
raise awareness of potential overuse of medical
"Reducing the overuse of health care resources is a
critical part of improving quality of health care in
America," said Dr. Risa Lavizzo-Mourey, the Robert
Wood Johnson Foundationís president and chief
"We want to see what can happen
when this work is targeted in specific geographic
regions and are pleased to help increase the
tangible impact of the Choosing Wisely