"The use of cardiac imaging has been increasing by 26 percent per year, despite a lack of evidence of outcome benefit." So writes University of California, San Francisco cardiologist Rita Redberg and a colleague in an article in tomorrow's New England Journal of Medicine that takes on the CT angiography industry. You can read it for free by clicking here.

Why do I feel so strongly that we must tackle the issue of useless medical procedures aimed at the worried well if we're ever going to get health care costs under control? This past year, I was told during my annual physical by my idiotic primary care physician that I ought to go in for a CT heart scan "just to be sure" I don't have any artery-clogging plaque. He gave me this advice even though I assured him that I exercise three or four times a week for a half hour without undue stress; I don't smoke; I have no family history of heart disease; I am not overweight; and my cholesterol is only slightly elevated over normal (and would be considered normal under guidelines from the mid-1990s). I eat red meat sparingly, eat plenty of fruits and vegetables and drink in moderation, mostly red wine.

"We're going to make you well," he said. "I'm not sick," I nearly yelled at him.

As the authors note at the end of this must-read essay:

The continued unrestrained use of new technology, in the absence of evidence-based criteria, portends a bleak future for Medicare and our health care system.

If you're interested in a careful dissection of the CT angiography industry, please read this essay.

Happy Thanksgiving!