Medicine: Going Overboard on Medical Tests

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These days, a medical encounter would hardly feel complete to either doctor or patient without a battery of diagnostic tests. The days when doctors' decisions were guided solely by what they heard, saw, felt and thought have gone the way of the house call. With 1,380 tests available, from blood counts to CAT scans to electrocardiograms, some 19 billion were performed last year in the U.S. That means almost 80 tests for every man, woman and child, which surely makes Americans among the most analyzed people on the planet. In recent years, the amount of testing has steadily increased, by 10% to 20% annually. The cost in 1987: more than $100 billion, or 20% of the nation's bill for health care.

There is a growing sense that the money is ill spent. Critics charge that doctors, through greed, poor judgment, or fear of malpractice suits, are ordering billions of dollars' worth of needless tests. Patients are willing accomplices, ever ready to put their faith in what appears to be scientific evidence, despite estimates that 20% of all tests performed are unnecessary. Worse, owing to sloppy laboratory work or doctors' mistakes, the results are too often wrong or misinterpreted; thus they may actually harm patients by failing to detect serious diseases or by indicating illness when none exists.

Error rates vary from one procedure or laboratory to another, but Pap tests and screenings for cholesterol are among those that are most often incorrect. The Federal Government monitors only labs that serve Medicare patients or do interstate business. State laws have been described by one investigator as a hopeless patchwork. Some laboratories submit to proficiency reviews in order to be certified by private professional groups, but thousands of other privately run labs are unregulated.

Inspired in part by a series of Pulitzer prizewinning articles that appeared in the Wall Street Journal last year, Congress is investigating medical tests with an eye to improving federal control. Within a few months, lawmakers will consider legislation, recommended by the Centers for Disease Control, to set up uniform proficiency standards for laboratories. At Senate subcommittee hearings on the subject last month, Democratic Senator Carl Levin of Michigan declared, "Faulty lab procedures can have devastating consequences for the unsuspecting."

Tragedies have certainly occurred. Among the most notorious have been cases of women who, despite negative Pap smears, turned out to have cervical cancer. ( Some have died; others have been forced to have hysterectomies. Had the disease been caught early, minor surgery could have sufficed. Pap smears miss between 20% and 40% of cancerous and precancerous specimens. Most often, the blame is laid on harried technicians who, paid according to the number of samples they process, may scan more than 100 slides a day with few breaks in so-called Pap-mill laboratories.