Guidelines say skip x-rays for lower back pain
Imaging scans to diagnose lower back pain are unnecessary in most cases and may do more harm than good, the American College of Physicians stated in new practice guidelines. Routinely ordering X-rays and CT or MRI scans drives up health care costs and does not help resolve the problem, the college's "best practice advice" guidelines say. On the contrary, the scans may pick up unrelated abnormalities, leading to additional tests or procedures that are of no benefit, and some scans expose patients to high levels of radiation. Most lower back pain is caused by strain on bones, muscles and ligaments. It can be treated with over-the-counter painkillers and usually abates within a few days, said an author of the practice guidelines, Dr. Amir Qaseem, director of clinical policy in medical education at the college. "Something like that can be identified by the physician taking a good plain old medical history," he said, adding that an X-ray or scan should be reserved for high-risk patients who have serious symptoms.
Study: Many tests for doctor's benefit
Another new study indicates that imaging tests such as MRIs and X-rays frequently are performed so doctors can protect themselves from lawsuits. A review of 2,068 orthopedic patients in Pennsylvania showed that almost 35 percent of the imaging costs were ordered for "defensive" purposes, researchers from Children's Hospital of Philadelphia reported Tuesday at the annual meeting of the American Academy of Orthopaedic Surgeons in San Diego. Medical malpractice lawsuits often hinge on charges that the doctor should have ordered more tests, said the lead author of the study, Dr. John Flynn, associate chief of orthopedic surgery at Children's Hospital. The study involved 72 doctors who voluntarily participated. Overall, 19 percent of the tests were ordered for defensive purposes. Defensive medicine isn't unique to orthopedics: A 2005 study of 824 doctors in the Journal of the American Medical Association found that almost 93 percent said they practiced defensive medicine.
Clinical trials don't use older adults
Older adults use a disproportionate share of medical services, yet one in five clinical trials examined in a study excluded patients because of their age, and almost half of the remaining trials used criteria likely to exclude older adults. The study, in the Journal of General Internal Medicine, analyzed 109 studies whose results were published in 2007 in the Journal of the American Medical Association, the New England Journal of Medicine, Lancet, Circulation and BMJ, among others. The average age of participants in the trials was 61. Many trials excluded participants who lived in nursing homes or had physical disabilities or existing medical conditions. While including older patients with complicated conditions in clinical trials may make them more expensive and difficult to carry out, "the population in a clinical trial should reflect the population that will be treated in the real world," said Dr. Donna M. Zulman, the paper's lead author.