A series of articles published over the past few years document cases of overuse of medical procedures. The studies look at mammograms, Medicare spending, proton pump inhibitors, and arthroscopic surgery, among others. While in some cases, medical invention is beneficial, often benefits are outweighed by the risks involved in the medical procedures used.

For example, antidepressants may be effective when used by those who are severely depressed. But the drugs may be much less useful for someone moderately depressed because the side effects outweigh the benefits. The patient takes the antidepressant and absorbs whatever risks taking the drug involves without receiving an equal benefit in terms of the alleviation of his/her depression.

Among mammograms, both older and younger women may have breast cancer risks. But the risk of dying is lower among younger women than older ones. Therefore, the benefit of a mammogram in relation to the risks involved in the procedure is lower among older women. Adverse effects of a mammogram include false positives, biopsies, anxiety, over-diagnosis and treatment of latent cancers which might not ever have become malignant.

When tests or procedures are repeated needlessly, harm is done if those procedures involve, for example, tomographic scanning to 'follow' renal stones or some other feature considered indicative of possible cancerous development; the radiation used in tracking could induce the feared cancer.

A study that examined regional differences in Medicare spending on patients hospitalized between the years 1993-1995 for conditions such as hip fracture, colon cancer, or heart disease concluded that enrollees in higher-spending regions received 60 % more care but did not enjoy better outcomes or greater satisfaction than persons in lower-spending regions. Another study came to the same conclusion but observed that in some cases preventive care was actually worse when more care was available.

Another study examined the use of high-tech devices and found that medical technology elevates health costs without a corresponding increase in health benefits. For example, implanted cardioverter-defibrillators, a battery-powered device implanted in the chest, were first used on people who had survived cardiac arrest. Later, their use was extended to those who had not experienced cardiac arrest.

However, in 90% of cases, the wearer is exposed to the risk of infection and possible shocks, without realizing any life-saving benefit. The devices cost $30,000, making them cost-effective only for those at risk of cardiac failure.

Similar findings were made in the use of CT and MRI scans. There is no evidence that CTs or MRIs improve or prolong life, or that their use is cost-effective. Yet this technology is used to screen patients.

In "Failing the Acid Test: Benefits of Proton Pump Inhibitors May Not Justify the Risks for Many Users" Michael H. Katz, MD, warns that proton pump inhibitors are overprescribed by 53 to 69 percent. Used for erosive and ulcerative esophagitis, Barrett esophagus, Zollinger-Ellison syndrome, gastroesophageal reflux disease as well as short-term treatment of ulcer disease, the drugs are also prescribed for 'inappropriate indications.' Risk factors include community-acquired pneumonia and changes in bone mineral density.

Reasons for over-prescription are fear of malpractice suits and the perception that less medical care means worse medical care.

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