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Some sports-medicine physician specialists are speaking out against what they see as the massive overuse of M.R.I. (magnetic resonance imaging) scans for sports- and exercise-related injuries, according to an article that ran this past weekend in the New York Times.

That overuse, say the specialists, is leading to misdiagnoses and unnecessary and often harmful treatments.

Writes Times reporter Gina Kolata:

M.R.I’s are not the only scans that are overused in medicine but, in sports medicine, where many injuries involve soft tissues like muscles and tendons, they rise to the fore.

In fact, one prominent orthopedist, Dr. Sigvard T. Hansen, Jr., a professor of orthopedics and sports medicine at the University of Washington, says he pretty much spurns such scans altogether because they so rarely provide useful information about the patients he sees — those with injuries to the foot and ankle.

“I see 300 or 400 new patients a year,” Dr. Hansen says. “Out of them, there might be one that has something confusing and might need a scan.”

“An M.R.I. is unlike any other imaging tool we use,” another physician, Dr. Bruce Sangeorzan, professor and vice chairman of the department of orthopedics and sports medicine at the University of Washington, told Kolata. “It is a very sensitive tool, but it is not very specific. That’s the problem.”

In other words, M.R.I. scans almost always turn up something abnormal, but most of those abnormalities are inconsequential and require no medical treatment.

Financial consequences
The cost of these scans certainly isn’t inconsequential, however.  Reports Kolata:

The price, which medical facilities are reluctant to reveal, depends on where the scan is done and what is being scanned. One academic medical center charges $2,721 for an M.R.I. of the knee to look for a torn ligament. The doctor who interprets the scan gets $244. Doctors who own their own M.R.I. machines — and many do — can pocket both fees. Insurers pay less than the charges — an average of $150 to the doctor and $960 to the facility.

The unnecessary treatments that result from these scans also have a monetary cost, of course, although Kolata doesn’t address that particular issue in this article.

Not many studies
Amazingly, as Kolata points out, only a few studies have looked into whether or not M.R.I. scans actually benefit patients. And nobody, apparently, has conducted a randomized, controlled trial — considered the gold standard of research — on this topic. (Such a study would randomize patients with symptoms into groups that either receive or don’t receive an M.R.I. scan and then follow them to see if their outcomes differ.)

Still, the studies that have been done have found that the scans don’t make a difference in patient outcomes — at least when used to diagnose suspected injuries to the shoulder, feet and ankles. Writes Kolata:

Dr. [Andrew] Green, [the chief of shoulder and elbow surgery at Brown University], and his colleagues reviewed the records of 101 patients who had shoulder pain lasting at least six weeks and that had not resulted from trauma, like a fall. Forty-three arrived bearing M.R.I.’s from a doctor who had seen them previously. The others did not have scans. In all cases, Dr. Green made a diagnosis on the basis of a physical exam, a history, and regular X-rays.

A year later, Dr. Green re-assessed the patients. There was no difference in the outcome of the treatment of the two groups of patients despite his knowledge of the findings on the scans. M.R.I.’s, he said, are not needed for the initial evaluation and treatment of many whose shoulder pain does not result from an actual injury to the shoulder.

A similar study involving foot and ankle patients found that nearly 90 percent of diagnostic M.R.I.s were unnecessary.

Patients are part of the problem
Physicians say they feel pressured — by patients and by concerns over possible malpractice lawsuits — to order an M.R.I.

“Patients often feel like they are getting better care if people are ordering fancy tests, and there are some patients who come in demanding an M.R.I. — that’s part of the problem,” a physician told Kolata.

You can read Kolata’s article on the New York Times website. (Remember: If you aren’t a Times subscriber, clicking on the link will count toward your monthly allotment of free viewings.)

Most Americans assume if a loved one or breadwinner is killed or seriously injured on the job, insurance — at the very least, the workers’ compensation insurance that states generally require employers to carry — will help with the resulting expenses.

But a pair of recent cases cast doubt on whether this system is working the way most participants expect.

Retired 26-year Las Vegas police sergeant Stan Cooper, 72, was working as an armed and uniformed security officer at the Lloyd George U.S. Courthouse in downtown Las Vegas, sitting in a chair near the metal detector when a disgruntled federal benefits claimant walked in and killed him with a shotgun blast on Jan. 4, 2010.

Yet Mr. Cooper’s son Marty was advised last month that his claim for payment under the 1976 federal Public Safety Officers’ Benefits Act had been denied, the Justice Department in Washington ruling “Claimant has not established that Court Security Officer Cooper was a public safety officer serving a public agency in an official capacity at the time of his death.”

Because Mr. Cooper was not married, no one is receiving his pension. His son also says no one in the family is eligible for any workers’ compensation benefits related to his death. “Every time we turn around, everything is just completely denied.”

In a separate and perhaps more outrageous case, we also learn this week of the plight of Mark Lindquist, 51, whose survival is considered a medical miracle. He has been honored as “a true hero and inspiration to others” by both houses on the Missouri legislature.

Mr. Lindquist, who earned slightly above minimum wage, felt he couldn’t afford medical insurance. But he would surely appear to have been “on the job” as he watched the skies darken on the evening of May 22 while driving to the Joplin group home where he was employed as a social worker, helping three middle-aged residents with Down syndrome.

The tornado sirens began to blare. Because there was no basement or shelter and the three residents moved too slowly to relocate, Mr. Lindquist and co-worker Ryan Tackett placed mattresses over the men, and then climbed atop the mattresses to add their own weight to the makeshift shelter.

More than 7,000 homes were destroyed. Sadly, the three men Mr. Lindquist was trying to protect were among the 162 dead. After the storm, rescuers found Mr. Lindquist buried in rubble, impaled on a piece of metal. Large chunks of his flesh were torn away. The bones in his shoulder crumbled as he was placed on a stretcher. All his ribs were broken, and most of his teeth were knocked out. He was in a coma for two months and had been rendered so unrecognizable that it took three days for his family to locate him in an area hospital.

Though he still carries his right arm in a sling, Mr. Lindquist can use the hand. He can see and walk and speak. Doctors consider his recovery amazing.

But perhaps not as amazing as the fact that, while Mr. Lindquist has run up $2.5 million in medical bills, Accident Fund Insurance, his employer’s workers’ compensation carrier, has denied his claim “based on the fact that there was no greater risk than the general public at the time you were involved in the Joplin tornado.”

Yes, insurers have to examine claims closely, aiming to keep premiums down by rooting out frivolous filings or outright fraud. But if these two claims haven’t resulted in expected benefits being paid, why are employers obliged to pay premiums to “insurers” with money that otherwise could be handed to workers for use to buy their own, private coverage, or simply to salt away against a future time of need?