There’s an interesting article in a recent issue of the New York Times exploring whether MRIs tend to encourage incorrect analysis of pain symptoms.
This doesn’t surprise me; there’s actually quite a bit of research on this topic. Books by the often mentioned Dr. John Sarno referenced the fact that people without back pain who undergo MRIs are often told they have some back deficiency. The book “How We Decide” by Jonah Lehrer also has a chapter on the topic. The history of MRI use, which I’m recalling from memory, is rather interesting. Essentially, people have had back pain for centuries. And when MRIs came on the scene, they were employed on back pain sufferers. The MRIs often showed some “abnormality” — a herniated disc or whatnot — and surgery would be recommended. A bit later — in the 60s or 70s — the medical establishment started using MRIs for stomach ailments like ulcers. Often they would find the source of the stomach pain, and also note something like, “this guy must have massive back pain as well. Look at his herniated discs!” Upon hearing this, however, the patient would say, “I don’t have back pain.”
From the New York Times article:
Dr. James Andrews, a widely known sports medicine orthopedist in Gulf Breeze, Fla., wanted to test his suspicion that M.R.I.’s, the scans given to almost every injured athlete or casual exerciser, might be a bit misleading. So he scanned the shoulders of 31 perfectly healthy professional baseball pitchers.
The pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. Andrews says.
…scans are easily misinterpreted and can result in misdiagnoses leading to unnecessary or even harmful treatments.
You might ask, “Why? Why would doctors utilize demonstrably false data?” As usual, it’s all about the Benjamins.
The price, which medical facilities are reluctant to reveal, depends on where the scan is done and what is being scanned. One academic medical center charges $1,721 for an M.R.I. of the knee to look for a torn ligament. The doctor who interprets the scan gets $244. Doctors who own their own M.R.I. machines — and many do — can pocket both fees. Insurers pay less than the charges — an average of $150 to the doctor and $960 to the facility.
Atul Gawande reported on this concept — the practice of doctors referring patients for tests that the doctors will gain financially from — in his now famous New Yorker article.
I have some personal experience in this matter as well. As I’ve mentioned, several years ago, I suffered from long-term dizziness and brain fog. A brain MRI was ordered to check for the telltale lesions of multiple sclerosis. A single lesion was found and determined not to be MS, but the doctors were basically incapable of providing an answer. About a year went by, during which I did some Internet research which led me to believe it was an inner ear issue. I went to an ear nose and throat doctor, and he dismissed my argument (incorrectly, it turned out.) He was interested in the brain MRI, but, during the course of the appointment, was willing to accept the findings of the previous doctors (that it wasn’t MS.) But at the very end of our meeting, he said something like, “Why don’t we go ahead and do another MRI just to be safe?”
So, I went ahead and did the MRI (at about $1500 cost to me, and much more to my insurance.) Several days later I called up the MRI lab. To help them find my record, I gave them the name of the doctor. They said something like, “Oh yes, we know him. He’s a frequent flyer.” (Meaning he orders a lot of MRIs.)
I found that suspicious at best. The doctor hadn’t seemed that interested in ordering the MRI until the tail end of the appointment. Had he ultimately decided that no harm could come of it, and his wallet might benefit? I don’t know, obviously. I only know one thing. Doctors are scum.
Oh, and by the way, a neurologist I saw later confirmed that the dizziness WAS an inner ear problem.