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Of Hydras, Lemmings, and Diagnostic Tests

Eugene D. Robin, MD
Arch Intern Med. 1987;147(10):1704-1705. doi:10.1001/archinte.1987.00370100018004.
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This issue of the Archives provides data collected by the Worcester (Mass) Heart Attack Study relevant to changes with time in the utilization of various noninvasive and invasive cardiac diagnostic tests in patients with acute myocardial infarction who were admitted to hospitals in Worcester, Mass.1

The study is directly relevant to the cost-effectiveness of various cardiac diagnostic procedures. More importantly, the results are also relevant to the general problem of the utilization of diagnostic procedures in all branches of medicine.

The specific results are hardly surprising. The use of three noninvasive and two invasive cardiac diagnostic tests increased dramatically from 1975 to 1984. The use of most diagnostic tests that become incorporated into medical practice, for at least a time, tends to increase dramatically with the passage of time. What is less obvious is that widespread acceptance of tests occurs without convincing evidence that performing a given test improves


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