A common medication cascade, in which treatment for a mild finding leads to side effects—and then more treatment. Illustration by The Epoch Times/Shutterstock
Posted on 12/30/2025 8:55:16 PM PST by SeekAndFind
A 52-year-old patient was newly committed to getting healthy—walking daily, eating better, and feeling strong—when a sharp pain flared in her chest. She assumed it was a pulled muscle, and subsequent tests looked normal. Still, her doctor ordered a cardiac CT scan “just to be safe,” Dr. Rita Redberg, a cardiologist at the University of California, San Francisco, recounted to The Epoch Times.
Her CT scan revealed no clear abnormalities. However, her doctor then ordered a follow-up catheterization that tore a major artery, forcing emergency surgery. Within months, she’d undergone bypass surgery, followed by more complications, and finally a heart transplant.
“She was perfectly normal when she walked in [to her doctor’s office],” Redberg said. “All this [happened] because a doctor ordered a test that shouldn’t have been ordered.”
First described in Archives of Internal Medicine and later cited in Redberg’s “Less Is More” series, the case has become a parable of the medical cascade—how one well-intentioned test can set off a chain of harm. Variations of this story unfold every day in exam rooms and hospitals across the country.
For instance, a patient may take antibiotics for a sinus infection, which clears up, but the drug may have unsettled her gut. Diarrhea could turn to bloating, with another drug prescribed to ease the side effects. Within weeks, the patient could be receiving treatments for the side effects of the medicine, rather than the illness itself. Researchers call this scenario a prescribing cascade.
A 2022 review found such chains are a leading cause of polypharmacy—patients taking multiple drugs at once. A 2023 study of over 7 million people identified 49 distinct cascade pathways, many of which were triggered by cardiovascular drugs. Older adults were hit hardest.
The same spiral can begin after a scan—even when nothing is technically “wrong.”
In a 2019 national survey, nearly every U.S. physician reported seeing cascades triggered by incidental findings: small nodules, borderline measurements, or anatomical quirks discovered while looking for something else entirely.
A CT ordered for back pain reveals a tiny lung nodule. An MRI for headaches shows a benign cyst. The finding is described as “probably nothing,” but it rarely ends there. Another scan is scheduled. A referral follows. Sometimes a biopsy.
Most physicians surveyed said these findings added little or no clinical benefit—but they still set off chains of follow-up testing, anxiety, and, in some cases, harm. “Families want twelve specialists, tons of medicine—they just want to fix every little thing,” Dr. Andy Lazris, a geriatrician and co-author of “A Return to Healing,” told The Epoch Times. “They don’t realize how dangerous that can be, especially as the body gets older.”
What appears to be thorough care can quietly pull everyone off course. Each step feels sensible in the moment. Only later does the pattern reveal itself. The chain is built from caution, not carelessness.
A common medication cascade, in which treatment for a mild finding leads to side effects—and then more treatment. Illustration by The Epoch Times/Shutterstock
In earlier reporting, we examined cases where symptoms persist despite “normal” test results, when more clarity is warranted. Cascades arise when that impulse flips—when tests uncover findings that don’t explain symptoms but still feel too unsettling to leave alone.
Imaging often fuels that chase. A 2024 global review estimated that of the more than 3.6 billion scans performed each year, up to half add little clinical value. The waste runs into billions of dollars, but the deeper cost is what follows: more procedures, more anxiety, and harm disguised as diligence.
Lazris said much of modern excess begins long before the test itself—not with recognizing decline, but with how medicine responds to it. “We’ve created epidemics out of numbers,” he said. “Every time thresholds shift—blood pressure, diabetes, bone density—we label more people as sick and reach for a medical fix.”
Once a label appears, medicine’s instinct is to act. “Even when there is nothing we can do that will lengthen life or improve quality of life,” Redberg said, “there seems to be a big incentive to do something anyway.”
The problem, both doctors argue, is not failing to notice early signs of change but mistaking medical intervention for the only—or best—response.
That impulse runs deep, and it is also structural. Nearly every physician in the 2019 national survey said they’d been drawn into cascades that began with an unexpected result. Most findings proved harmless, but the process rarely stopped there. Once a test reveals something, it’s hard not to keep looking.
In the United States, physicians are often compensated based on the volume of services provided, rather than the outcomes achieved. “We get paid for doing things,” Redberg said. “It’s hard to think that doesn’t shape the culture, even unconsciously.”
Yet money isn’t the only driver. “It’s a reactive system,” Dr. Todd LePine, who is board-certified in internal medicine with four decades of experience, told The Epoch Times. Doing something feels like progress, but sometimes waiting would serve the patient better.
Redberg sees the same psychology on both sides of the exam table. “We’ve confused care with intervention,” she said. Patients share that reflex. “I’ll ask how they’re feeling, and they’ll say, ‘You tell me, Dr. Redberg.’ They’ve learned to equate health with test results.”
Between doctors eager to help and patients expecting action, medicine can trap itself in motion. Reassurance comes from another scan, not a conversation—however, “People aren’t reassured by tests,” Redberg said. “They’re reassured by someone who listens.” For patients navigating a system built on intervention, it’s not always easy to see when good care begins to go off course.
What to Ask: What problem are we still monitoring, and what would change if we stopped?
What to Ask: Are the numbers driving my treatment, or how I’m actually doing?
What to Ask: What are we hoping to find, and what would we do with that information?
What to Ask: What are the risks of doing nothing right now?
What to Ask: Which drug can we taper first, and how will we know it’s safe to do so?
What to Ask: Can we reduce or stop the original medication instead of adding another?
What to Ask: What is the main goal of my treatment right now—and does it still match my original concern?
Not every cascade is harmful. Some interventions are necessary and even life-saving. However, knowing when care has drifted from your true goal is the first step in regaining control.
That idea runs counter to how most of us think about health care. We’re taught to fix, intervene, and keep moving. But medicine doesn’t always reward speed.
“Time itself is in your favor,” said Lazris. “Especially in older adults—going slow is crucial.” A brief period of watchful waiting, accompanied by a clear follow-up plan, can help distinguish between problems that resolve on their own and those that require care.
Slowing down is not about withholding care—it is about resisting reflex. The same tools that save lives can also start a chain reaction when used without a clear purpose. Knowing when to wait or stop takes judgment and trust. Helping doesn’t always mean acting, Redberg said. “Sometimes talking and reassuring are the most important things we do.”'
What’s Next: Slowing medicine down is only part of being a wise patient. The next step is knowing when to begin—especially with the screenings meant to keep us healthy. Our next article explores what to ask before saying yes to routine tests, and how to balance prevention with the risks of overdiagnosis.
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I have experienced this several times.
“Routine” scan shows “something” in lungs...
Get sent to lung Dr. to check...
He says probably nothing, but
come back every 6 months to be sure...
One scan shows “something” in adrenal gland...
He sends you to the adrenal Dr.
Adrenal Dr. does a scan and says it is nothing, but,
the scan shows something on your aorta, so
he sends you to the cardio-vascular Dr....
I call the system the “Medical Mafia”
once you get in you ca never leave.
Just been there myself with whatever it is that triggered my health problems in Aug/Sept.
Got sent to specialists who all told me I’m fine, I don’t need to come back to see them.
Got LOTS of medical bills the ins. co. is still dragging its feet about paying.
I’m convinced that much of it is CYA testing to prevent getting sued later because they didn’t pursue something someone could later claim they could have.
And specialist appointments now take months to get because of shortages of medical personnel. Or this kind of nonsense.
What a racket. Guaranteed income with the help of other DRs.
I stumbled on this guy on you-tube.
Dr. Suneel Dhand
BIGGEST MEDICAL TRAGEDY In Modern History: Caused By The Medical Profession
https://www.youtube.com/watch?v=Ua7t1jPQ1VA
He and his fellow doctors here are very critical of the US industrial medical complex and big pharma. And they discuss a lot of things many doctors won’t touch.
The system doesn’t make money off of well people.
It also takes advantage of hypochondriacs who are constantly creating maladies.
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