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AAPM 2025 - 67th Annual Meeting & Exhibition of the American Association of Physicists in Medicine

Ethicists Discourage Use of "Unproven" Screening Tests

By MedImaging International staff writers
Posted on 21 Apr 2009

Ethicists have concluded that whole-body computed tomography (CT) scans and other, what they deem unproven, screening tests have significant risks, and physicians should generally discourage their use when such tests lack data and professional support for their use.

Private companies offer access to these new tests--such as lung scans for smokers, magnetic resonance angiography (MRA) to detect cerebral aneurysm, and whole-body CT--without referrals from a primary care physician. But such testing creates ethical problems, according to the authors of the report, which was published in the March 31, 2009, issue of The American Journal of Bioethics. "Under most circumstances, physicians should discourage individual patient access to screening exams prior to conclusive evidence and professional society endorsement," stated Drs. Ingrid Burger and Nancy Kass, from Johns Hopkins University (Baltimore, MD, USA).

Good evidence supports the use of other screening tests such as colonoscopies, pap smears, and mammograms, according to Drs. Burger and Kass. But problems arise, they reported, when entrepreneurs and doctors encourage access to whole-body CT, which may detect cancer early but has never been proven to save lives. "CT exposes patients to radiation, and high false-positive rates may lead to invasive, risky, and costly follow-up procedures," said Drs. Burger and Kass. "Further, the detection of pseudo disease--that is, cancers that grow so slowly that they never produce symptoms or impact a patient's health---leads to interventions and treatments that provide no medical benefit and may pose significant risk."

Widespread adoption of unproven tests outside clinical trials may also slow research to characterize their risks and benefits, the investigators reported in their article. Some such trials are underway, such as the U.S. National Lung Screening Trial, which has enrolled 50,000 smokers to see whether CT screening for lung cancer can save lives. It will cost approximately US$200 million over eight years. "Randomized controlled trials of screening tests can require thousands of patients, years of follow-up, and high costs to complete," Drs. Burger and Kass conceded.

In light of these obstacles, the researchers contended that physicians may sometimes have compelling reasons to use an unproven screening test for high-risk patients who place a high value on the results. The authors proposed four guidelines to help doctors use new screening tests ethically before there is solid evidence to support their use: (1) Physicians should fully understand the epidemiologic basis for screening tests and the tendency of patients to overestimate the value of screening. (2) Physicians should understand the state of the evidence and professional recommendations surrounding screening tests. (3) Physicians should advocate for research to assess new screening tests and the tendency of patients to overestimate the value of screening. (4) Physicians should understand the state of the evidence and professional recommendations surrounding screening tests. (5) Physicians should advocate for research to evaluate new screening tests. (6) Physicians should not engage in direct-to-consumer advertising of screening tests.

"Consumers may falsely infer that any screening exam advertised by physicians offers more benefits than risks and/or is recommended by physicians as a whole," stated Drs. Burger and Kass. "Given the high likelihood of misleading patients, consumer advertising before screening is endorsed for a population, in our view, is unprofessional."

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62 (508.06999206543): SELECT fid FROM jos_deeppockets WHERE id=294722884 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722884 AND published='1' LIMIT 1

63 (303.98368835449): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

64 (57.93571472168): select jos_twitters.link from jos_twitters where cat=10

65 (36.954879760742): select jos_facebook.link from jos_facebook where cat=10

66 (34.093856811523): select jos_google_plus.link from jos_google_plus where cat=10

67 (29.087066650391): select jos_linkedin.link from jos_linkedin where cat=10

68 (36.001205444336): SELECT fid FROM jos_deeppockets WHERE id=294722884 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722884 AND published='1' LIMIT 1

69 (31.948089599609): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

70 (257.01522827148): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722884 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (210.04676818848): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722884 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (37.193298339844): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (47.922134399414): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722884 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722884 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (32.901763916016): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (62.942504882812): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

105 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

106 (51.975250244141): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722884 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (48.160552978516): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722884 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

109 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

110 (51.021575927734): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294722884 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (441.07437133789): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294722884 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (531.91184997559): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (310.89782714844): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (68.187713623047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

115 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

116 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

117 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

118 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

119 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

120 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

121 (39.815902709961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

122 (322.10350036621): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 19180.059432983): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (527.14347839355): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722884 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722884 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7233.8581085205): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (114.91775512695): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (53.167343139648): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (359.05838012695): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (42.915344238281): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (30.994415283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (28.133392333984): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (471.11511230469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (315.90461730957): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (191.92695617676): SELECT name FROM jos_deeppockets WHERE id=215

138 (31.948089599609): SELECT name FROM jos_deeppockets WHERE id=215

139 (609.15946960449): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (463.96255493164): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

142 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

143 (!!!!! 8843.8987731934): TRUNCATE TABLE jos_trademed_module

144 (139.23645019531): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722884 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (79.154968261719): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722884 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1025.915145874): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

149 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

150 (!!!!! 1134.1571807861): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (88.214874267578): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

152 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

153 (61.03515625): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722884 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722884 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (467.06199645996): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

155 (51.975250244141): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

156 (41.007995605469): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (88.214874267578): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

158 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722884 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722884 AND published='1' LIMIT 1

159 (39.815902709961): select jos_twitters.link from jos_twitters where cat=10

160 (39.815902709961): select jos_facebook.link from jos_facebook where cat=10

161 (44.822692871094): select jos_google_plus.link from jos_google_plus where cat=10

162 (41.007995605469): select jos_linkedin.link from jos_linkedin where cat=10

163 (263.92936706543): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

164 (!!!!! 1127.0046234131): insert into jos_banners_delta values (14202,'2025-06-29 11:45:50','216.73.216.249','view'),(14203,'2025-06-29 11:45:50','216.73.216.249','view')

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