President Bush: Test Case For Too Much Testing

Recently former President George W. Bush had surgery to implant a stent.  The stent helps keep one of his coronary blood vessels open after a blockage was discovered.  This took place following his annual physical, and the procedure took place without incident.

There is some legitimate medical discussion about whether it should have happened at all.  Mr. Bush reportedly demonstrated no symptoms of heart disease, and has maintained a very active lifestyle for a 67-year-old man.  As two doctors write in The Washington Post today, it is unlikely that a good internist seeing the former President for an annual checkup would not have conducted any cardiac screening.  However, since Mr. Bush’s physician ordered a stress test, an abnormality in that test prompted another test and the blockage was eventually found.

And these tests – or at least how frequently they are used – are the problem.  Stress tests for people not in high-risk populations have been shown to have marginal impact on symptoms (of which the President had none) or survival.  The stent procedure has similarly negligible impacts on survival.  Mr. Bush most likely feels worse coming out of the hospital than he did going in, and now must take additional medications.  All for what may be a marginal improvement in his survival.

The extensive screening given to the President is of a kind with some of the other screenings that are conducted far too often for many people.  (We are talking about those outside of high-risk groups.)  Whether it’s breast cancer screening, prostate-specific antigen screening for prostate cancer, CT scans, or other medical tests, it’s important to measure more than just knowing a possible diagnosis.  The consequences of the screening need to be measured against the possible benefits, and barring additional risk factors, many tests are unnecessary for a lot of people.  Whether or not they can afford it or are ‘important enough’ to have lots of medical attention.

So while the history of cancer in Angelina Jolie’s family made her choice for breast cancer screening and preventative mastectomy more understandable, the average person with average risk factors doesn’t need such aggressive testing or treatment.  It’s unfortunate that the former President appears to have undergone an unnecessary procedure, and that the blood thinners and related complications of his stent probably aren’t worth it.