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AIIMS doctors lead the way, wage war on unnecessary medical tests -Rema Nagarajan
-The Times of India


NEW DELHI: Top cardiologists of the All India Institute of Medical Sciences (AIIMS) here have decided to start an initiative called the Society for Less Investigative Medicine (SLIM) - a movement that aims to take on the growing menace of excessive medical investigations, starting with cardiology.

Several studies across the world have conclusively established that generalized annual health check-ups are unnecessary and add enormously to healthcare costs without any commensurate benefits. Several other screening tests and investigations have also been similarly shown to make little sense - other than adding to the bank balance of diagnostic centres and doctors who get a cut for sending patients for tests and investigations.

This unhealthy practice has prompted Prof Balram Bhargava of the cardiology department in AIIMS, one of the key people behind SLIM, to raise an alarm over over-investigation, a practice that has become rampant simply because economic incentives were skewed in favour of recommending unnecessary tests.


"But there is no regulation or audits on investigations to determine if they are necessary," said Dr Bhargava. "Even in the US, where privatization is rampant, there are audits and guidelines regarding investigations, and the health information technology used in most of the developed countries make it possible to retrieve and check data to see if a particular investigation or procedure was necessary. We need similar checks in India to stop this practice. Rather than preventive check-ups of CT scans, angiograms and treadmill tests every year, it's more useful to track risk factors," said Dr Bhargava.

He pointed out that the government too was wasting a lot of money by offering annual health check-up to its Group 'A' officers above 40 years of age under the Central Government Health Scheme.

'Need checklist on symptoms that warrant tests'

Already a number of top doctors have endorsed the scathing criticism of Dr Samiran Nundy, one of India's leading gastroenterologists, of kickbacks and bribes that oil every part of the healthcare machinery. One of the doctors, Dr MK Mani, chief nephrologist in Apollo Hospital in Chennai, has drawn MCI's attention to this - but to no avail.

SLIM is envisaged as an initiative to sensitize people about the kind of unnecessary probes being pushed and will also draw up guidelines on when investigations or screening are required.

"To begin with, we will be drawing up guidelines for investigations and procedures related to cardiology. Then we will be reaching out to doctors from other disciplines to draw up similar guidelines for their own fields so that there is a readily available check list on what circumstances warrant the different kinds of diagnostic tests and procedures," explained Dr Bhargava, adding that in the UK such dubious practices could invite strong action from the General Medical Council, which was an effective deterrent.

In an article in the British Medical Journal (BMJ) titled 'General health checks don't work', Prof Peter C Gotzche, medical researcher and director of the Nordic Cochrane Centre, along with two doctors, wrote that systematic trials in Europe and the US have found that general health check-ups had no effect on total mortality or on mortality due to cardiovascular disease or cancer.

"Screening programmes for healthy people are justifiable only when randomized trials clearly show that benefits outweigh harms. For health checks, the trials seem to show the opposite. No discernible benefits were seen, and, although harms were inadequately reported, health checks would be expected, like screening tests, to increase over-diagnosis and over-treatment, with their associated side effects and psychological consequences," stated the article.

The authors advised doctors against offering general health checks to their patients and dissuaded governments from introducing health check programmes.