Are You Being Overtreated?

Here are some areas where you should proceed cautiously, according to the Choosing Wisely program (created with input from more than 30 U.S. medical societies) and the BMJ’s Too Much Medicine program

by Christie Aschwanden
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Photograph: lenetstan/

Low back pain (nonchronic)
Advice: Skip the X-rays, CT scans and MRIs. Back pain almost always goes away on its own within a few weeks. Studies show that people who get imaging tests for back pain are more likely to end up having surgery, but they don’t recover any faster than those who didn’t get imaging. What will usually tame the pain is a combination of heat and over-the-counter anti-inflammatory medications such as aspirin, ibuprofen or naproxen. Staying as physically active as you comfortably can will expedite your recovery.

Pelvic exam
Advice: Don’t get a pelvic exam or other physical exam when you’re just asking for oral contraceptive medications. Pelvic exams have become a standard part of the yearly gynecologist visit, yet they have no clearly defined purpose, and there’s no solid evidence that they do any good if you have no symptoms. Birth control pills can safely be prescribed on the basis of your medical history and a blood pressure reading, according to the American Academy of Family Physicians.

Advice: Avoid frequent use of proton pump inhibitor (PPI) drugs like Nexium, Prevacid and Prilosec.  When used long term, PPI drugs increase your risk of bone fractures and reduce your magnesium blood levels, potentially triggering irregular heartbeats and convulsions. Heartburn and gastroesophageal reflux disease (GERD) are often overdiagnosed, and most people who truly have these conditions can control them with dietary and lifestyle changes and antacids (such as Rolaids or Tums) or H2-blocker medications (such as Pepcid AC and Zantac).

Pap test
Advice: If you’re 30 to 65 years old, experts recommend that you have this test every three years (every five years if you’ve had a clean HPV test). Cervical cancer progresses slowly, and yearly testing increases your risk of overdiagnosis without improving your odds of detecting a serious cancer. Most women who’ve had a hysterectomy can skip the screening altogether, as can most women over 65.*

Bone-Density Scans
Advice: If you’re at low risk, have your first scan at age 65.  A DEXA scan (dual-energy X-ray absorptiometry) can detect low bone mass, and many women who have the scan come away with a diagnosis of osteopenia, aka preosteoporosis. Even though the condition isn’t necessarily worrisome, the osteoporosis drugs often prescribed for it can pose serious risks. Who should have a DEXA scan: women at high risk for the disease, meaning they have suffered fractures from minor trauma and/or have a parent who has broken a hip.

An earlier version of this story suggested that Pap smears are not necessary for women who have had hysterectomies. While this is true for the vast majority of women who have undergone the procedure, Pap smears are still recommended for women who have had cervix-sparing hysterectomies. However, according to Cheryl B. Iglesia, MD, professor in the departments of Ob/gyn and urology at Georgetown University School of Medicine, only a "small percent" of the 600,000 hysterectomies performed annually are done in such a way as to spare the cervix.  In any case, we do urge any reader contemplating a hysterectomy to discuss with her surgeon whether she should continue getting Pap smears after the surgery.

Related: Are You Getting Too Much Medical Care?
Next: The New Science of Living Longer

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First published in the December 2013/January 2014 issue

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