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Medical tests & treatments you should ask questions about

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People & their doctors are wasting money on potentially harmful tests and treatments, these are for cancer, Alzheimer’s disease, coeliac disease & sexually transmitted infections, a new study says.

As more experts recognise people are receiving far too much medicine, 4 groups that specialise in genetics, sexual health, radiology and gastroenterology have produced advisement to curb wasteful and sometimes damaging medical practices as part of the “Choosing Wisely” regimen.

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Choosing wisely programme aims to reduce tests that are not required

On the list are colonoscopies, because of fears they’re being done too often, and genetic tests for markers associated with Alzheimer’s Disease, coeliac disease, and blood clots.

Blood tests for sexually transmitted infections such as herpes, chlamydia and gonorrhoea are also being questioned, along with certain cancer treatments and proton pump inhibitor drugs used to treat heartburn and reflux.

While many of these tests and treatments are effective in certain aspects, there are concerns they’re being used in inappropriate situations where their negatives will outweigh their benefits.

According to NPS MedicineWise, which is co-ordinating the campaign, the drivers of what it calls “inappropriate use” can include marketing and financial incentives for those who will profit; patient demand and doctors not wanting to refuse tests; and doctors not being aware of the latest evidence about best practice in medical literature.

Professor Anne Duggan from the Gastroenterological Society of Australia said medical practitioners  were being urged to check the National Health and Medical Research Council guidelines for colonoscopies, because patients may be having them done unnecessarily for surveillance, putting them at risk of bleeding, tears, inflammation and infection.

Her group has also called for less genetic testing for coeliac disease.

Professor Duggan said because the coeliac gene can be found in one third of the population and a positive result does not make coeliac disease a certainty, doctors should instead be using blood tests when people are consuming an appropriate amount of gluten.

If the blood test is positive, a biopsy is required to confirm the result.

Professor Jack Goldblatt from the Human Genetics Society of Australasia said he was concerned about the rise of genetic testing too, and particularly “direct to consumer” tests because they can lead to unnecessary investigations, worry, and ethical, social and legal issues such as insurance problems.

He said tests for APOE and MTHFR genes were sometimes being done without good reason.

“APOE is considered a risk or susceptibility factor for Alzheimer’s disease, but having a test only shows a probability, so people undertaking a test for APOE can also risk being falsely reassured,” he said.

MTHFR is an enzyme that converts folate which has previously been linked to venous thromboembolism (blood clots), heart disease and recurrent pregnancy loss.

But Professor Goldblatt said testing for a variant in the gene was not useful because variants are very common and having a variant doesn’t generally cause health problems.

President of the Australasian Chapter of Sexual Health Medicine Dr Graham Neilsen said his group was trying to reduce testing for herpes when people do not have symptoms because the tests can be inaccurate and do not specify the timing or site of a previous infection.

This can lead to a false impression that somebody has had contagious genital herpes when they might have had a cold sore caused by the herpes virus during their childhood.

“That’s potential dynamite in a relationship,” he said.

“The conclusion may be that a partner has been unfaithful or from a patient’s point of view, they might believe their sex life is over because they’re terrified they will transmit it to their partner or their baby if they get pregnant, and all that could be completely and utterly wrong.”

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Henry Sapiecha

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