Danger of medical imaging

  There is an article on MSNBC about the increase in imaging in the last 15 years. The general idea of the article is great, though not very surprising or novel. A basic summary is that the number of imaging studies have increased, they cost a lot, there is a risk of incidental findings and CT's have a risk of radiation. Unfortunately, as with most pieces of medical journalism, there's a lot that is left out, it's filled with errors and the word choice tries to get the most shock value.
  Here's the title: "MRI, CT scan use spikes, study finds. Should we be worried?" It is true that there are more scans being performed today than ever before, but it has been a gradual increase with the spread of imaging technology throughout the country over the last few decades. That's hardly a "spike." Then, of course, there's the meaningless "Should we be worried?" The proper place for "Should we be worried?" in a title is for a threat that you can't do much about (i.e. "Rat shit found in drinking water. Should we be worried?"). No one is forced to get scans and, although there are a lot of unnecessary scans performed, it is not something that the public needs to start stocking up food rations for. A proper question would be "Should doctors change?"
  The article goes on to talk about magnetic "resource" imaging and PET scans that use MRIs. Both incorrect and a sign of how sloppy this article is. Then, he talks about cost, false positives and this:

The biggest danger of all with scanning comes from CT, or computed tomography. A CT scan exposes the patient to huge amounts of X-rays. One CT scan of the chest, for example, zaps a patient with the same amount of radiation as 150 old-fashioned X-rays. In their survey of medical records, the authors of the latest study found that 3.9 percent of patients were receiving an exposure or more than 50 millisieverts every year. In comparison, that is about the equivalent of the one-time amount that the Japanese government estimates that the nearby residents of the Fukushima power plant got in the hours before they evacuated.

 Yes, CT scans have a large amount of radiation. But, it's disingenuous to pick one of the higher radiation forms CT. High-resolution CT scans looking for specific types of lung disease have the same radiation of "150 old-fashioned X-rays," but most common chest CT's have less than half of that. There are new low-dose CT scans that have less than a tenth of that. I'm not saying that even those low levels are completely safe, but it's not right to make something seem worse than in actually is. What's worse is comparing the amount of radiation exposed to patients over the span of a year, to the high-dose, one-time exposure that the Japanese living near Fukushima got. It makes no sense. Over our lifetimes, cumulatively, we get exposed to an enormous amount of radiation from just normal background sources. That doesn't mean that our daily exposure to cosmic rays is the same as being in an nuclear war zone.
  Overall, MSNBC and Dr. Robert Bazell wasted an opportunity to present the problem of overuse of medical imaging to a biased, mistake-filled useless article that tries to scare people away from all types of imaging.

Computer overlords

Oh, no. NPR, you did it again. I've said before that journalists make terrible science reporters, but this is just bad. A computer beat two Jeopardy champions pretty easily. It was an interesting game to watch and an amazing feat of technology, but Martin Ford, a computer programmer and writer decided that winning at a game show is enough evidence to show that computers can take over medicine, emphasizing on radiology. He said, "Radiologists basically focus on looking at visual images from medical devices — things like X-rays or CAT scans, that type of thing. Now, machines are getting much better at analyzing that type of visual information."

Arrgh! Radiology is not just looking at images. It isn't even just pattern recognition. It's putting together information from a vast number of sources (patient history, previous scans, pathology, physical properties of the imaging technique, variances in image acquisition, positioning of patient, etc.) To be an effective radiologist, you can't just look at every image with the same formula (if you can, who needs a radiologist?). That's a start, but personal experience at interpreting images and intuition about what the image and patient history points to adds a lot. It's that intuition that looks more closely at an image or orders a different view that makes the diagnosis.

I don't doubt that computers will eventually able to do this, but just because one won at Jeopardy, doesn't mean that it can start replacing radiologists. In reality, if computers get good enough to accurately interpret all types of images (at least with the same accuracy of radiologists), then they'll be good enough to take an effective history, perform a physical exam, order and interpret appropriate lab tests, perform procedures or even surgery and prescribe medications. The only medical specialty that would be safe is psychiatry (that is, until it starts using real science also). I don't see that happening in my lifetime, and if it does, we'll be living in a pretty different world.

Just looking at pictures

Julie Rovner, the health reporter at NPR took a little swing at lazy radiologists by saying that all they do is sit in a room at look at pictures while primary care physicians have a lot of high-stress work. Maybe radiologists have a more cush lifestyle (although, I know a lot of people who wouldn't be able to stand doing what radiologists do), but it looks like Julie Rovner hasn't really researched what radiologists actually do and what merely "looking at pictures" actually means (i.e. invasive procedures, deciding whether someone needs an organ removed, deciding if someone needs a brain biopsy, etc.). Wtf, NPR? Maybe you should hire a health reporter that actually knows something about health.

This just points out the fact that most science/health reporters suck. They are trained as journalists, not scientists, but they have no problems making conclusions about science/medicine without actually knowing what they are talking about.

Breaking News on CNN

Let's see, what happened today? The entire east coast is getting like 2 feet of snow, the healthcare bill got enough votes to avoid a filibuster, the climate conference in Copenhagen comes to an end, and Lil' Wayne gets arrested for pot possession... and none of these stories make the biggest headline on CNN. Instead it's Can Joel Osteen Help You Pay Your Bills? and the poll of the day is "Should information about women who get abortions be posted online?" WTF?? This is what the media has become? A big advertisement for a televangelist as the major headline and a poll that in a country that supports human rights should be 100% No?? Just when I think that US media can't get worse, it proves me wrong. I think I gotta take a tip from my friend, MadDR2 and give up on the news for a bit.

Compulsory medical blog swine flu posting

To tell you the truth, I haven't been following the swine flu epidemic (pandemic?) too closely (too busy trying to finish up that dissertation), so I'm not going to comment on it much (see here and here for the important, life-saving info). One thing that this highlights, though, is how easy it is for the media to scare the public. I'm not saying that it's not warranted now, but the media's tendency for wild speculation will probably end up making things worse, rather than better.

Update: My drug dealing wife (pharmacy student) says that lots of health professionals were calling in today asking for prescriptions of oseltamavir for their family members... lame.