The night before my annual medical visit I spent a near sleepless night dealing with issues related to my daughter’s illness. During that night I felt irritation in my right eye. In the morning I realized I was spraying mouthwash all over the bathroom because I could not keep the right side of my mouth firmly closed. It was clear to me at that moment that I had developed Bell’s palsy, a paralysis of the facial muscles only on one side. “It results from a dysfunction of cranial nerve VII (the facial nerve).[1] Many believe that this is due to a viral infection that results in swelling.[1] Diagnosis is based on a person’s appearance and ruling out other possible causes.” My wife’s friend immediately pinned the cause as stress. In any case, I was not too concerned because my brother had this condition last year and as is stated in the Wikipedia article, “The condition normally gets better by itself, with most achieving normal or near-normal function.[1]”
The doctor insisted I must submit to an MRI of my brain to be sure the paralysis was not due to a tumor or stroke. I went to a center in Paris that charged me 140€ out of pocket. It is rare to pay for a prescribed test in France. As the old joke goes, they did a brain scan and found nothing. In spite of this result, the radiologist at the center still recommended I return for a second scan a couple of months after the symptoms were resolved. I was incredulous and responded with the French expression “C’est n’importe quoi,” commonly used in daily French to indicate that something is nonsense or BS. After several direct questions regarding the logic of the second scan he sheepishly admitted that it was the organizational recommendation for every case.
During the same annual visit the doctor noted that the blood test that estimated kidney function was out of the healthy range the previous couple of years (58 which is below the limit of 60 mL/min/1.73 m2), which could indicate I had developed chronic kidney disease. The previous year I had noticed this result myself impelling me to check the scientific literature on this test that I had known nothing about. I found this pertinent paper, Aging and Renal Disease: Old Questions for New Challenges – Google Scholar. From the introduction I learned about the problem.
Chronic kidney disease (CKD) is increasingly being recognized among the elderly population, which pose significant challenges for clinicians around the world [1-3]. Many elderly people are diagnosed with CKD based merely on declining estimated glomerular filtration rate (eGFR) [4], but whether this is a process of normal aging or disease development remains controversial.
Later, in the discussion in the scientific paper I found this important observation.
The diagnosis of CKD by eGFR <60 mL/min in older people has been criticizing [sic] for overestimating the CKD burden in the elderly population because eGFR generally declines inversely with aging, and reduction of eGFR to 50-59 mL/min/1.73 m2 does not increase mortality risk among patients ≧65 years compared to patients with eGFR of more than 60 mL/min/1.73 m2 [12,13].
In more simple words, the eGFR blood test doesn’t indicate anything important for older people (I am 66) and their kidney function. Thus, I was anticipating a difficult discussion with the doctor. What he did do is prescribe a different test that more directly gauges kidney function by measuring the amount of protein in urine over a 24 hour period.
Last year when the doctor measured my blood pressure it was high for the first time in my life. He was wearing a mask. I think this fact as much as anything else elevated my indignation and blood pressure. My blood pressure was elevated again this year.
The overuse of medical testing and resulting unwarranted medical care is reported in the scientific literature. A sample of papers are: Informing wise choices: Development of a conceptual map of negative effects of overuse on patients (escholarship.org), Employee Wellness Program Outcomes: A Case Study (researchgate.net), Overuse of diagnostic testing in healthcare: a systematic review (bmj.com), and Mammography screening is harmful and should be abandoned – PMC (nih.gov)
The mother of all medical testing scams was PCR testing for COVID-19. Consider the following data from Taiwan. The key message from the plot below is that when testing declined cases and hospitalizations declined. The mortality that followed was likely due to the deadly care (e.g., mechanical ventilation) patients received in the hospital.
The doctors are not stupid, it is medical education that needs to be examined. They are trained to fit the modern bureaucratic mindset that simply follows the numbers (test results). Yet they have no training in understanding how the measurements are made, nor the bias and precision errors inherent in the measurements. These concepts were fundamental to the engineering measurements courses that I taught when I was a professor.
The doctor asked me to return in a couple of weeks to discuss the results of these tests. As noted above, the MRI was negative and all of the symptoms were resolved. The urine test showed that my kidney function was fine. And on top of the good news, my blood pressure was back to normal on the second visit. So being in very good health what did the doctor do? He gave me a prescription for a tetanus vaccine. I think my blood pressure went back up.
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