In a post several months ago prompted by an article on mistaken full-body irradiation of infants in a New York hospital, I explained how dangerous can be the radiation that comes with some forms of medical diagnostic imaging, particularly CT scans and X-rays.  Rather than replow old furrows, allow me to quote from the follow-on post, explaining how to determine whether or not to allow a diagnostic test employing radiation (mainly CT’s and X-rays):

The question isn’t whether it is dangerous.  The question is whether a dose of radiation such as is contained in an X-ray or CT scan costs the body too much in potential danger relative to its benefits.  The answer is that it depends.

 The first question to ask when a doctor tells you that he wishes to take an X-ray or get a CT scan is “why”.  If he replies with an answer that I want to see if “A” condition exists so that I’ll then know to follow “B” procedure in treating it, then it might be okay to go along with the irradiative procedure, so long as the condition he’s checking for is actually worth treating AND the treatment strategy depends on the knowledge he will gain by dint of the procedure AND there is no other non-irradiative means of gaining the same information.  Would an MRI work?  How about an ultrasound?  Will the treatment be the same regardless of what the procedure reveals?  If the answer to all three of these questions is no, and the condition is worth treating, i.e., at least moderately serious and not likely to go away without treatment, then allow it.

If instead, he answers something like “I just want to know more about what’s going on in there” or “I just want to rule something out”, take out your medical- skeptic blinders and grill him.  Satisfying a doctor’s curiosity is not a sufficient reason to subject the body to radiation.  Neither is calming his nerves about his legal liability.   Information about the inner processes of the body is not free.  Some comes at very low cost, like the needle prick to draw blood for a combined blood count.  Some is exceptionally expensive, such as biopsy of a potentially-diseased organ that requires surgery for retrieving a tissue sample.  But always, no matter what type information is sought, the best way is the least invasive way that will get the required information. 

Irradiative medical imaging is invasive and costly to the body in hidden ways.   It is cumulative.  Each dose adds to that already received.  Its effects take years to manifest, long after the doctor ordering the test has ordinarily passed from view as the culprit.  A single extra X-ray can’t be traced to a cancer diagnosis, but like the Senator’s knives plunging into Caesar, each dose contributes to the diminishment of life expectancy.

To summarize, here’s the test to determine whether a requested diagnostic procedure is indicated, or just preferred:

1)  Is the condition made the subject of the diagnostic procedure worth treating?  If yes, then;

2) Is the information likely to be revealed in the procedure relevant to treatment?  In other words, do treatment strategies depend on knowing what the diagnostic procedure reveals? If yes, then;

3) Is the chosen diagnostic procedure the least invasive/insulting means of acquiring the desired information (keeping in mind that medical imaging with radiation, i.e., X-rays and CT scans, are heavily and cumulatively invasive and insulting, though they may appear to be as harmless as an ultrasound)?

Medical imaging using irradiative procedures is a sensory-extending tool.  It is very effective at revealing secrets the body hides from our eyes.  But it is not cost-free to the body; though the skin may remain unbroken, it is not non-invasive, and should never be considered as such, by either the doctor or the patient.

The validity of employing the three-prong test before allowing a CT-scan or X-ray has been bolstered by a recent study, published in the British medical journal, Lancet, and reported in the Wall Street Journal today (June 7, 2012), showing that CT scans done on children yield a higher rate of cancers, particularly leukemia, later in life, than would be expected without the scans.  The study excluded children who already had cancer in order to ensure they didn’t skew the results.  An excerpt of the article:

The report found cancer risk grew with each scan received, and there was an elevated risk even in those who received only one CT, also known as a CAT scan.

Previous studies raised concerns about cancer risk from the scans; this report offers the first direct evidence of the magnitude of the link. It examined the U.K.’s National Health Service records of patients who had received a CT before age 22 and looked at their medical history for an average of 10 years afterward.

“This paper confirms that radiation, even in relatively low doses, does lead to risk” of certain cancers, said Alan Craft, emeritus chair at Newcastle University and an author of the paper. “There is no safe dose.”

Radiation comes in many forms and from many sources–sunshine; electromagnetic devices around the home, office and car; minerals in the earth, tanning beds, and of course, medical imaging and treatment devices, such as CT scans and X-rays and cancer treatments–all of these emit radiation of various types.  And all radiation, of every type and source, can be harmful to living things.  The threshold of irreparable, long-term harm is determined by three factors–the intensity of the radiation, its type and its duration. 

Take for example, tanning beds.  The highly intense UV-A and B radiation of a tanning bed can only be endured for a short time, else the skin would suffer tremendous damage.  It suffers enough in a ten-minute dose to initiate the skin’s darkening process–the skin’s answer to excessive sunshine–that would otherwise generally take several hours under a temperate-climate sun in normal conditions, which is why tanning beds are so dangerous, and also why so many young women are developing deadly skin cancer (melanoma) as result (discussed more fully in a previous post).

Sunshine is the most common and powerful radiation to which we are routinely exposed, but our bodies have evolved to account for and repair the damages it causes in order that it might enjoy its benefits (primarily the synthesis of vitamin D, which is critical to proper cellular functioning throughout the body).  Evolution and adaptation works slowly, however, so while a black African could readily weather the scorching sun of equatorial Africa, as he has been evolutionarily adapted to do so, a pale Northern European might do himself serious harm if he didn’t take precautions against that same sun upon returning to the land of his evolutionary origin.  While one can never be completely sure about adaptive purposes behind evolution, the fact that the farther from the equator one proceeds, the lighter is the skin of the natives, it is not unreasonable to conclude that light skin is an adaptation intended to intensify sun absorption so that the body can synthesize its proper measure of vitamin D.  In effect, skin color is the mechanism through which nature balances, in the human animal, the benefits of radiative sunshine against its harm. 

What nature balances, man rips asunder.  The American medical community’s obsession with tests has resulted, according to the cited article, in a four-fold increase in CT scans since the 1990’s, as the following chart (also from the article) indicates:

CTSCANS

This is malpractice on a gargantuan scale.  It is utterly irresponsible medicine, inflicting harm with no ensuing benefit, exactly the opposite of what Hippocrates provided was the first prerogative of medicine.  To be sure, not all these CT scans are unnecessary, but a four-fold explosion in their usage?  Unless it is assumed that doctors were failing in the early 1990’s to get clinically-critical scans in order to have poignantly relevant information in making immediate treatment decisions,  then the only conclusion is that doctors are today ordering unnecessary scans, inflicting long-term harm on their patients with no real benefit, except perhaps to the pocketbooks of the doctors ordering and administering the scans.

I suspect the explosion in CT scan usage has three causes.  First,  doctors protect themselves from liability by ordering the fullest battery of tests available when an ambiguous diagnosis presents itself.  Second, doctors fully well understand that it takes years for the effects of one extra CT scan or X-ray to manifest, so disregard the potential problems they might cause.  Last, Medicare pays for practically any test a doctor deems necessary, and any market with a purchaser willing to purchase all the output of a product will produce a great and excessive amount of the product.  This last reason is probably the base reason for the explosion in CT scans.  The others are corollary.  Medicine carries no exemption from the laws of economics. 

Which brings us to the final point:  Government meddling in the medical delivery market is literally, just like the wars that government propagates, killing people.  There would be less irradiative testing were every test not reimbursed by some government agency, and as stated in the article lead-in, radiation is like war, inherently dangerous and harmful for children and other living things.

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