Are All Health Care Related Blogs Newsworthy?

On a recent visit to The Health Care Blog, I ran across a blog entry by Dr. Robert Wachter, the undisputed father of Hospitalists and Hospitalist Medicine.  In this most recent post he references an article by a colleague cautioning the potential dangers of CT scans, at least the unnecessary ones, which can, in and of themselves, cause cancer.  Because of the seriousness of the conclusions drawn by the article and the blog post, no less than four (and now five) articles/blogs have referenced that blog in their own articles or blogs.  An excellent comment was posted soon after the original entry by Dr. James A. Brink, Member of the American College of Radiology ,and their Chair for the Commission on Body Imaging.  His comment was informative and very well referenced.  But, it was also largely ignored by the remainder of the commenters at the site.  Dr. Brink, in essence, agreed with Dr. Wachter, in that no test, regardless of type should be ordered if unnecessary.

Despite Dr. Brink’s thoughtful comments, references and concise writing, including his conclusion, what everyone else will likely read is the more sensational article or blog which will likely raise fear in the hearts of the reader; “There is a strong biologic counterargument to the notion that low levels of low-LET radiation are carcinogenic (2, 5). Tubiana et al (5) report, “there is no evidence of a carcinogenic effect for acute irradiation at doses less than 100 mSv and for protracted irradiation at doses less than 500 mSv.” As these radiation doses are grossly in excess of doses delivered with a single 10 mSv CT scan, it is imprudent for those in group 1 to base medical decision-making solely on these risk estimates. Rather, practitioners should operate under the premise of group 2. As Smith-Bindman advocates (6), “we must ensure that patients undergoing CT receive the minimum radiation dose possible to produce a medical benefit.” One of the best ways of reducing radiation is to assure the appropriateness of the ordered test and to eliminate tests that are not indicated. Of greatest concern is the possibility that patients in need of medical imaging may be denied the benefits of modern health care owing to an unproven and uncertain risk of cancer.”

It is unfortunate that the power of the internet, blogs and ready access articles, also make for the presentation of one sided discussions, leaving excellent comments like this one behind.  The goal seems to be, just like in print news, to be the first with “breaking news.”  Sell the papers with a sensational story on page one; print the retraction on page 30.  With the web, you really have to dig and check all the references, comments, blogs, etc., to get at the true story.  You can’t simply take anything at face value.

My take away from the original article, blog post and comment is;  There is a risk associated with the radiation exposure from any imaging procedure. The exact amount of that risk and any future consequences is likely small, but potentially real.  Order those tests which are necessary to treat your patient.  If it isn’t necessary, it isn’t worth the risk, no matter how small.

Doc B.

My opinion is free.

Advice is worth exactly what you pay for it.

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