Cecily O'Connor
RedwoodAge.com

Got a slipped disc? You might reconsider the back surgery your doctor is advising. There’s a good chance the procedure isn’t your best option.

Back surgery is one of 10 treatments and tests Consumer Reports lists as overused by the medical profession. The consumer advocacy group maintained that some physicians have become so focused on profit that preventative care is sliding. 

These days, the majority of doctors hospitals are paid on a "fee for service" or “piecework basis,” meaning the more services they provide - blood tests, surgeries, MRIs, etc. - the more money they make. It’s estimated the nation's $2 trillion annual healthcare tab is one-third to one-half higher than need be, in part because of overuse of expensive treatments and unnecessary care. 

“Health-care costs are ballooning, partly because the system is geared toward expensive interventions and remedies after health problems develop,” according to the consumer group, which will publish the results  in November. "The US doesn't have a system in place, notes one doctor, for rewarding the education of patients as to why it's important to change behavior to improve their health. And many new physicians are avoiding the primary care field altogether; new medical student graduates, often saddled with six-figure student loans, are increasingly opting to forsake primary care for the bigger paycheck of a specialist."

The message to patients is to make sure you don’t get shortchanged. If you’re at risk for heart disease, stroke, diabetes or cancer, talk to your doctor and come up with a plan to manage the condition. We all want to feel better, and fast, but some cures may not always fix what is ailing you. 

To that end, the consumer group identified 10 overused tests and treatments, basing its conclusions on several recent medical studies:

1. Back surgery: In 90 percent of cases, the pain goes away on its own within six weeks. In more stubborn cases, surgery, which can run $20,000 plus physician fees, can alleviate pain somewhat faster than physical therapy and medication. But both groups of patients wound up with similar improvements after two years.  
2. Heartburn surgery: A surgical tightening of the sphincter muscle that blocks stomach acid from backing up into the esophagus typically costs $14,600 or more, and provides no better long-term relief than taking a proton-pump-inhibitor drug, which is less than $1 a day.
3. Prostate treatments: Prostate cancer surgery can cost $17,000 or more and is often done without adequate discussion of the alternatives or the high risk of incontinence or impotence.  
4. Implanted defibrillators: One-third of people who get these devices might not really need them. Medicare will this year pay for an estimated 50,000 of the devices, which automatically shock the heart back to a normal rhythm. Each device costs some $90,000 over a lifetime.   
5. Coronary stents: Billions are spent each year inserting tiny mesh tubes to prop open coronary arteries. But the procedure, plus heart drugs, turns out not to work any better to prevent future heart attacks than heart drugs alone for patients with stable coronary artery disease.
6. Cesarean sections: At an approximate cost of $7,000 - 55 percent more than natural delivery - most C-sections are performed because labor is progressing too slowly. This procedure was used for a record 30.2 percent of births in 2005. But several less-invasive approaches might be enough to speed up labor.   
7. Whole body screens: At a cost of $1,000 or more, CT scans have no proven benefits for healthy people, according to the Food and Drug Administration. Plus, they expose patients to more radiation than X- rays.  
8. High-tech angiography: Using a CT scan to non-invasively check coronary arteries for narrowing costs an average of $450. But standard angiography is sometimes still needed to confirm blockages that might require aggressive treatment.  
9. High-tech mammography: Using software to flag suspicious breast X-rays would add $550 million a year to national costs if used for all mammograms. A 2007 study found it failed to improve cancer detection rates significantly while resulting in more needless biopsies.  
10. Virtual colonoscopy: A  2007 study concluded that standard colonoscopy is better at spotting smaller suspicious polyps. While less costly than the standard procedure, virtual colonoscopy isn't cost-effective because any suspicious finding requires retesting with the real thing.

Recommendations
To be sure, this list is intended to inform, not diagnose, so discuss your condition with your doctor. Ask what it means if test results are positive. Then ask which treatments have been shown by research to be best for a given condition.

It’s important to be just as vigilant when it comes to prescriptions. For example, if you’re offered a newer drug, ask your doctor if it has been proven better or safer than predecessors and generics.