Wednesday, September 8, 2010

Bad Medical Advice from Men’s Health Magazine and Yahoo

Here is some incredibly stupid advice from Men’s Health magazine in August which was given more exposure today by Yahoo Health. It’s from an article about allegedly common misdiagnoses. The advice is in italics.

Diagnosis: Appendicitis
What you might really have: An inflamed lymph node or stomach virus

Despite advances in diagnostic screening, 16 percent of appendectomies are performed on patients who don't need them, according to a recent University of Washington study. Appendicitis can be deadly, so doctors are quick to remove the 6-centimeter organ before doing a CT scan to confirm the diagnosis. An inflamed lymph node or virus could produce similar symptoms (and not require surgery).

Your strategy: If blood tests reveal that your white-cell count is over 10,000 cells per microliter, ask for a CT scan of your stomach.


A previous blog post of mine discusses the diagnosis of appendicitis in detail.

Let me dissect (pun intended) this erroneous advice line by line.

Despite advances in diagnostic screening, 16 percent of appendectomies are performed on patients who don't need them, according to a recent University of Washington study. This is outdated information based on an article from an administrative database. As my previous blog post points out, it does not reflect the current accepted misdiagnosis rate for appendicitis, which is well below 10%.

Appendicitis can be deadly, so doctors are quick to remove the 6-centimeter organ before doing a CT scan to confirm the diagnosis. This is patently untrue. According to a study from Cornell and consistent with my experience and that of many others, over 90% of patients undergoing appendectomy in the 21st century undergo a CT scan before their surgery.

An inflamed lymph node or virus could produce similar symptoms (and not require surgery). This rather simplistic statement is sort of true but incomplete. Many other illness can be confused with appendicitis.

Your strategy: If blood tests reveal that your white-cell count is over 10,000 cells per microliter, ask for a CT scan of your stomach. The white blood cell count is a very soft indicator of appendicitis. It can be normal in more than 10% of cases and an elevated white blood cell count is non-specific. The white blood cell count can be elevated in many diseases that are not appendicitis.

There is also the question of unnecessary radiation exposure and a possible increased risk of later developing cancer which suggests that the last thing one should do is tell people to request a CT scan because of some arbitrary white blood cell count threshold. This is a prime example of why you should not get your health advice from the internet.

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