We already know that scores of drugs, tests, and treatments are overused in this country on a regular basis. That’s no surprise.
But here’s what is surprising: There’s a movement to stem this overuse — and it’s coming from some of the nation’s most prominent medical groups.
They’ve published a list of tests and treatments that are often unnecessary. If any of them are being recommended to you, I strongly urge you to study this new advice first. Links are provided below, based on the medical problem being treated — plus some other valuable tips. . .
Continued below. . .
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The new effort is called the “Choosing Wisely” campaign, and it was launched last April by nine major medical societies, including the American College of Physicians, the American College of Radiology, and the American Society of Clinical Oncology.
The main goal of the campaign is to curb unnecessary medical interventions. Supporters of Choosing Wisely say part of the overuse problem comes from patients who demand their doctors give them tests (even if they don’t have symptoms), as well as patients who want to re-do a test to see if they get the same results. The other part of the overuse problem stems from doctors who regularly over-test. Some do it to avoid liability suits; others get a cut of the profits from the tests.
When the initiative first came out, an article in The New York Times said “By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.”
The article quoted the physician-in-chief at North Shore-LIJ Health System, Dr. Lawrence Smith, as saying, “Overuse is one of the most serious crises in American medicine.”
Consumer Reports even pointed out (correctly, I might add) that all the unnecessary CT scans and X-rays taking place can expose you to potentially cancer-causing radiation.
Finally a step forward in health care safety and quality
It’s nice to see doctors admit they’re not always right. But more powerful is the fact that it’s a first step in changing the culture of medicine. They’re admitting their tests can be wrong. And that they don’t know everything. They’re asking you to be more involved with your own healthcare.
You can access summaries put together by Consumer Reports Health and the various participating medical societies. The summaries are meant to help you understand when certain tests are needed and when they aren’t. They include video messages, “Easy Read,” and Spanish versions:
- Allergy Tests (AAAAI)
- Bone-Density Tests (AAFP)
- Chest X-rays (ACR)
- EKGs and Exercise Stress Tests (AAFP)
- Imaging Tests for Back Pain (AAFP)
- Imaging Tests for Headaches (ACR)
- Imaging Tests for Ovarian Cysts (ACR)
- Immunoglobulin Replacement Therapy (AAAAI)
- Painkillers (ASN)
- Pap Tests (AAFP)
- Spirometry for Asthma (AAAAI)
- Treating Heartburn and GERD (AGA)
- Treating Sinusitis (AAAAI)
- Treating Sinusitis (AAFP)
- Choosing Wisely: When to say ‘Whoa!’ to doctors
The complete list of recommendations is available at www.ChoosingWisely.org.
Just some of the anti-treatment recommendations…
One of the recommendations to curb overuse is that dialysis patients with limited life expectancy and no sign of cancer should not get routine cancer screenings. These screenings don’t add any time to the person’s life, and sometimes they give false positives that lead to stress and over-treatment.
The findings also confirm my belief that oncologists should scale back on tests for early-stage breast cancer and prostate cancer patients.
Other recommendations include:
- Fewer EKGs when there’s no sign of heart trouble
- Fewer MRIs at the slightest hint of back pain
- Fewer antibiotics prescriptions for sinusitis
- Fewer imaging scans for people with simple headaches
- Fewer CT scans for people who faint but have no other neurological problems
I have some personal experience with most of the items on this list, and I agree these tests are usually a waste of time. I don’t know how many times I was X-rayed when I was young for chronic back pain and chronic headaches without the doctors coming up with a diagnosis or with any answers for my problems (alternative medicine did that).
Keep in mind — it’s not like we haven’t seen this before, where an effort is made to curb unnecessary health spending. But this time the message comes from powerful organizations of medical specialists — the last place you might expect.
Who knows, this could be the first step away from our culture of thinking doctors are gods instead of checking things out for ourselves. If the recommendations get the attention they deserve, it should jumpstart health conversations between doctors and patients, instead of almost everything being decided from on high by the doctor-authority figure.
Some question the movement’s motives
Needless to say, some critics have found fault with the Choosing Wisely initiative. Mainly, they argue that these new recommendations give insurance companies a pretext to red-light expensive testing. The fear is that they’ll reference the Choosing Wisely campaign and decline legitimate requests for tests.
It all comes down to whether the suggested guidelines will be used to help make better, more informed decisions — or as an excuse by payers to limit a patient’s options.
I think the weight of the evidence is that we do too much testing.
And people who worry about out-of-control medical spending in our country often point out that the vast amount of money we spend on testing saves very few lives. This newsletter has been extremely critical of PSA screening for prostate cancer and mammograms to screen for breast cancer. The stats clearly show the expensive failure of all the prostate and breast screening and the aftermath of biopsies and over-treatment.
Don’t forget what happened in 2009 when the U.S. Preventive Services Task Force recommended fewer mammograms. It made sense and was supported by the facts, but there was a backlash of fear over what some called “rationed” treatment. It was charged the Task Force was willing to let women die in order to save money. Utter nonsense. Mammograms are a medical disaster.
But doctors test for many things besides cancer. Are heart and circulation tests, for example, a waste of money?
In 2010, Consumer Reports did a study on 1,200 healthy men and women between age 40 and 60. Even though none of them had risk factors or symptoms for heart disease, roughly 44 percent had undergone heart disease screening tests. That’s right — nearly half the people who showed NO SYMPTOMS of the disease had been tested.
That’s not necessarily a bad thing. People can have high blood pressure and clogged arteries without knowing it. But I suspect one of the main screens was a cholesterol test, and the treatment for those who tested high was statin drugs.
Now this is me talking, not the Choosing Wisely people, but the evidence suggests that cholesterol is a red herring and the anti-cholesterol drugs not only don’t prevent heart attacks, they actually damage the patient in other ways. The only group known to benefit from statin drugs is men who have ALREADY had a heart attack. For men who have never had a heart attack — and for ALL women — there’s no benefit from these cholesterol-lowering drugs.
Better care? Cheaper care? Both?
Let’s take a closer look at the campaign specifics. The Choosing Wisely campaign — which by the way, unites the recommendations of nearly 375,000 physicians across the country — lists 45 treatments and tests as commonly overused. The list results from a multi-year effort by the ABIM Foundation (Advancing Medical Professionalism to Improve Health Care).
Each of the nine physician specialty societies picked five tests or procedures in their fields that they consider overused. That strikes me as odd — that each specialty had exactly five treatments to pinpoint as unnecessary. My guess is they have a lot more than that, but capping it at five makes them look less irresponsible as physicians than a list of 20 would.
Some health experts say as much as 30 percent of our $2 trillion health care spending is unnecessary, duplicative, and potentially harmful. Another study suggests most elderly adults are screened regularly for breast, cervical, prostate, and colon cancer, despite the patient guidelines that advise against these screenings for anyone over age 75.
What should come out of this? Besides improved patient care, the hope is that financial incentives for doctors to run extra tests will eventually become a thing of the past.
By the way, since the initial announcement of this campaign last April, 17 new specialty societies have joined the initiative. Sometime this fall they’re expected to announce their lists of tests and treatments to scale back on.
If you’re curious, the Choosing Wisely partners are:
- American Academy of Allergy, Asthma & Immunolgy
- American Academy of Family Physicians
- American College of Cardiology
- American College of Physicians
- American College of Radiology
- American Gastroenterological Association
- American Society of Clinical Oncology
- American Society of Nephrology
- American Society of Nuclear Cardiology
And the societies that have joined the campaign since the initial effort are:
- American Academy of Hospice and Palliative Medicine
- American Academy of Neurology
- American Academy of Ophthalmology
- American Academy of Otolaryngology-Head and Neck Surgery
- American Academy of Pediatrics
- American College of Obstetricians and Gynecologists
- American College of Rheumatology
- American Geriatrics Society
- American Society for Clinical Pathology
- American Society of Echocardiography
- American Urological Association
- National Physicians Alliance
- Society of Cardiovascular Computed Tomography
- Society of Hospital Medicine
- Society of Nuclear Medicine and Molecular Imaging
- Society of Thoracic Surgeons
- Society for Vascular Medicine
Lee Euler, Publisher