Monday, June 25, 2012

Why we are seeing an epidemic of overtreatment

English: A small uterine fibroid within the my...
 A small uterine fibroid within the myometrium as seen on ultrasound 
Many women in the reproductive age group have fibroids. These are the commonest tumors in the reproductive tract – and most are small and don't cause any mischief . They are found only if you go looking for them  ! In the past, a lot women who had fibroids would not even be aware of their presence, because they had enough sense not to go to a doctor. However times have changed, because our technology has become so much better , and doctors have become very good at marketing their services.

Ultrasound scans are now done at the drop of a hat - and with an ultrasound scan , it's possible to detect fibroids which are as small as one centimeter – about the size of this O. Now  a one centimeter fibroid in the wall of the uterus is tiny and asymptomatic , and doesn’t cause any problems. However, when the sonographer reports a one centimeter fibroid as being 10 millimeters, and reports this “ finding “ in bold print, patients get worried , because they think it's an abnormality , and they want their doctor to fix it.

Doctors are always happy to do so , but in the past, when removing the fibroid involved surgery , patients had enough sense to say no , because they were understandably scared of going under the knife. However, now the technology has become so good that the surgery itself is minimally invasive. In fact , today you don't even need surgery to treat the fibroid - they can be shrunk , using high-frequency ultrasound waves . This is done under MRI guidance, and the technique is called HIFU or High-Intensity-Focused-Ultrasound .

The marketing departments of the manufacturers of these machines ( and the hospitals which they sell these costly devices to) are having a great time ! They run huge ads in papers and on bill boards, to target women ! “ Do you have a fibroid ? pelvic pain ? heavy bleeding ? Come to us – and we will treat it without surgery ! “

They claim to create awareness about this common complaint through these campaigns – and will even hold free camps, to help unsuspecting women discover that they have fibroids ! However, rather than inform women that most fibroids are quiet and can be happily left alone, they scare them into believing that these fibroids are responsible for all kinds of complaints , ranging from backache ; vaginal discharge; heavy bleeding ; abnormal bleeding and infertility. Now these are extremely common complaints in women and it’s a mathematical certainty that the majority of women who have fibroids will have one or more of these complaints. Usually, the fibroids are just innocent bystanders , so that “ treating “ the fibroid will not help the patient to get any better ! However, treating the fibroid will help the doctor because he can charge for his medical treatment . Even worse, since a lot of patients now have insurance to cover their medical treatment , they will often sign on the dotted line to get this “latest medical treatment”. Because they're not paying out of their own pocket , the risk of moral hazard leads to overtreatment.

Patients need to learn that just because the doctor happens to find an abnormality, this doesn't mean that it needs to be treated ! We are seeing an epidemic of unnecessary intervention , thanks to clever marketing and the explosion of technology.

The only solution is information therapy , where patients have access to an objective reliable, unbiased source , which will provide information which they can trust . Patients need to learn that they can make the right decisions for themselves – and that there’s no need to “treat” something which is not causing them any problems !

While it's true that the high frequency ultrasound treatment represents a significant advance for treating selected women with fibroids ( as compared to regular surgery , because it saves the patient an operation), it is also equally true that it is no better than no treatment at all , because lots of fibroids don't need to be treated in the first place. This is something which people forget when they make comparisons, especially when they are out to promote and sell a particular kind of therapeutic intervention.

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1 comment:

  1. At what size of the fibroid should we be alert/worry about?


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