MRI specifically is overused and kind of crappy in Japan. In the rest of the world, the standard is for a 1-3T MR study; in Japan, you get a lot of 0.5 and even lower (0.2T! wtf) MR studies. They're used for a lot of health screenings, whereas in the rest of the world they're more often used for actual problems.

I call bullshit on your first point--that MRIs are "overused" in Japan.

MRIs aren't something that can really be overused. Unlike CT scans, or pretty much any non-MRI method of imaging the inside of the body, they don't harm the patient.

Even though you are right that many of the MRI machines in Japan are lower-resolution cheaper models, that is largely because there are way more MRI machines here, and they are used for routine diagnostics, to find actual problems. Your local single-doctor clinic in the boonies often has mRI equipment here.

I have a personal interest in this topic, as I have MS. Lucky for me, I am doing fine, but in Japan I get a brain MRI every 6 months just to keep an eye on how it is going. When I was back in the states 3 years ago I had a typical employer-based HMO. I went to the doctor and told him here's my deal, I have MS, my doctor in Japan said I should have another MRI in October to see what's up with it.

The doctor flatly refused -- MRIs were only available after physical symptoms had developed. Of course, at that point, the available treatments for a flare-up of MS are less effective at preventing long-term neurological problems. (Happily, I am back in Japan now.)

My point is that MRIs are a wonderful tool, and as you and other commenters have pointed out, they are much more widely used here than in the US. Something wonky with your knee? OK, let's get an MRI and check it out. I don't see anything wrong with that.

And in cases where there is a problem, there is no difficulty at all here in getting a referral to a specialist at a hospital with the latest cutting-edge MRI gear if necessary.

Using MRI technology for health screening and preventative/proactive treatment is great.

>MRIs aren't something that can really be overused.

Not on the basis of exposure to anything dangerous, but certainly they can be overused on cost grounds. That is the case in the US. They are routinely ordered without an adequate indication; we order many times more than physicians in other countries.

All the rads I've talked to/worked with hate "screening" MR (or CT! Some morons do CTs for random checkups!) not so much for the cost of the procedure (since they directly or indirectly were getting paid), but because it leads to finding basically insignificant incidental findings which then cause the patient to worry, and/or have unnecessary surgery. The benefits are questionable if anything, but the costs of the unnecessary surgery are high.

A needs-based study based on having MS, sure, but just getting an MRI as part of a routine checkup, probably not.

Exactly this. Unnecessary imaging needs to unnecessary follow-up evaluations like biopsies which in turn have additional complications.

When I was in med school we spent a lot of time in a hospital providing indigent care. We ordered tests that we needed to determine how to treat someone, but not more than that. When I worked in a private hospital, most patients got lab tests done daily, with no specific reason for ordering them.

I'd be willing to buy that imaging is sometimes underused with some patient populations, and sometimes overused -- just like medications, even painkillers, which are dramatically overprescribed in some places (old people, Florida, pill mills for diversion) and underprescribed for others (some chronic pain patients, terminal care).

I don't doubt your experience.

Now, what if imaging were free ... wouldn't the solution be to use it all the time but fix the tendency to over-treat harmless irregularities/growths, rather than using it selectively? Or is fear-of-malpractice preventing this?

> Something wonky with your knee? OK, let's get an MRI and check it out.

Maybe; let a doctor look at it and decide. An MRI may be useful. It might just provide complex hard to interpret images that don't provide any more information than an experienced orthopod could find with some manipulation.

> Using MRI technology for health screening and preventative/proactive treatment is great.

You need to provide some evidence for that claim. There's a number of flaws.

Giving everyone screening MRIs needs many more staff. Those staff are diverted from other areas of healthcare, so that's one negative impact.

You'll get bottlenecks in screening and interpreting results, so some people who need treatment may end up waiting longer than someone who's just getting a screening MRI.

MRI scans are complex and hard to interpret. Knowing that every MRI is called for by a doctor makes people screening them look hard for problems. Knowing that there's a bunch of screening of probably healthy people means that screeners may not look so hard, and may miss minor (or major and hard to see) problems.

A patient who is healthy but who has a blob on MRI will be under considerable stress until that blob is investigated and ruled safe.

Investigations carry some risk. You have to drive to the hospital (which will cause many deaths and injuries); you're mixing with ill people; you're increasing the number of people visiting hospitals and thus increasing the numbers of people with MRSA and NORO virus and etc visiting hospitals - you're increasing the number of healthy people carrying illnesses visiting hospitals which have people unable to resist those illnesses.

That's just off the top of my head. I'm sure there are many more problems.

But I don't have numbers, so I can be persuaded if someone has good quality reports.

"The doctor flatly refused -- MRIs were only available after physical symptoms had developed. Of course, at that point, the available treatments for a flare-up of MS are less effective at preventing long-term neurological problems. (Happily, I am back in Japan now.)"

There's your mistake. You didn't see a doctor who owned (or who had bought a share in) an MRI machine. Those doctors are 4.2 times more likely to refer patients for MRI than doctors who don't.

Is this because as the price drops more applications become cost-effective?

From what I've been told (I used to do research in MRI), it's because MRI's are Japan's preferred method for allowing doctors to show they care.

MRI's are used in Japan the way antibiotics are used in the US. Patients are often unsatisfied if the doctor tell them to go rest and hope things improve on their own (even if that is the best treatment), so doctors perform some harmless token medical procedure to make the patient feel he helped them.

At least MRI doesn't really screw the patient much, and doesn't screw society at all, unlike overprescription of antibiotics.

(I'm in favor of complete availability of most scheduled drugs -- narcotics, pot, LSD, whatever -- but restriction of antibiotics to those with a prescription. Drug resistant bacteria is no joke.)

There's probably some argument for 0.5T MR being diagnostic now, with faster computers. I just think Japan pushed to low-field earlier because they don't actually care about the results. Also Japanese tend to be physically smaller, so maybe a 0.5T there is as effective as a 1T in the land of the super-sized drive-through.

Antibiotics are restricted to those with a prescription in most European countries, for the reason you mentioned. That said, I still keep some in reserve (purchased via prescriptions from doctors in my family) to use judiciously when traveling or living abroad without wanting to deal with the local healthcare system.

That's basically true, but I'd just point out that MRIs really are harmless, unlike unnecessary antibiotic prescriptions.

I took 4 MRIs last month in Japan. The first one (lower back) was ~$100. The rest (left foot, right foot, upper back) were each on average about half that at Medical Scanning:

http://www.medicalscanning.net/access/shinjuku/

That was what I paid out of pocket, which is 1/3 of what the clinic actually charges. Insurance paid the remaining 2/3 of the cost.