Medicine
One seemingly contradictory notion in health reform, which generally aims to improve everyone's access to health care services, is that in most medical situations, less is actually more. I've written previously about why it may be better to "just say no" to blood tests that you don't really need. Recently, Forbes.com published an article that highlighted several medical tests or procedures that doctors commonly provide, but probably have no health benefit compared to no treatment or safer, less expensive therapies. I list these below, with links to some relevant scientific articles and guidelines:
1) Vertebroplasty for spinal fractures from osteoporosis
2) Minimially invasive ("robotic") surgery for prostate cancer
3) Continuous fetal heart rate monitoring during labor
4) Coronary artery disease screening
5) Excessive high-tech (CT) imaging
6) Newer drugs for schizophrenia (remember my mental health success story? That patient likely would have done just as well taking an older, cheaper drug with fewer side effects)
7) Hospitalizations for syncope (fainting spells)
8) Spinal fusion for back pain
9) Knee arthroscopy for arthritis
The Forbes article suggests that as much as $650 billion of the United States's $2.5 trillion annual health care expenditures are probably unnecessary; other experts, such as the New America Foundation's Shannon Brownlee, suggest that the tab could be even more. (If you want to read more about this issue, I strongly recommend her book Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer.)
If these therapies don't work, then why do doctors keep providing them, and insurers, for the most part, keep paying for them? Are they just not familiar with the evidence? Do they have some ulterior financial motive? Or is there something else going on here? What do you think?
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After the American Academy of Orthopaedic Surgeons (AAOS) released its Choosing Wisely list, it was criticized for selecting items that are uncommonly used or have little effect on the income of its members. In an editorial in the New England Journal...
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A few days ago I was reminiscing about my family medicine residency, where at one of my outpatient training sites I provided care to Amish patients in rural southern Lancaster County, Pennsylvania. The Amish didn't believe in checkups and rarely visited...
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Recently, I had a conversation with Shannon Brownlee (the widely respected science journalist and acting director of the Health Policy Program at the New America Foundation) about whether men should continue to have access to the PSA test for prostate...
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Medicine
When less health care makes sense
One seemingly contradictory notion in health reform, which generally aims to improve everyone's access to health care services, is that in most medical situations, less is actually more. I've written previously about why it may be better to "just say no" to blood tests that you don't really need. Recently, Forbes.com published an article that highlighted several medical tests or procedures that doctors commonly provide, but probably have no health benefit compared to no treatment or safer, less expensive therapies. I list these below, with links to some relevant scientific articles and guidelines:
1) Vertebroplasty for spinal fractures from osteoporosis
2) Minimially invasive ("robotic") surgery for prostate cancer
3) Continuous fetal heart rate monitoring during labor
4) Coronary artery disease screening
5) Excessive high-tech (CT) imaging
6) Newer drugs for schizophrenia (remember my mental health success story? That patient likely would have done just as well taking an older, cheaper drug with fewer side effects)
7) Hospitalizations for syncope (fainting spells)
8) Spinal fusion for back pain
9) Knee arthroscopy for arthritis
The Forbes article suggests that as much as $650 billion of the United States's $2.5 trillion annual health care expenditures are probably unnecessary; other experts, such as the New America Foundation's Shannon Brownlee, suggest that the tab could be even more. (If you want to read more about this issue, I strongly recommend her book Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer.)
If these therapies don't work, then why do doctors keep providing them, and insurers, for the most part, keep paying for them? Are they just not familiar with the evidence? Do they have some ulterior financial motive? Or is there something else going on here? What do you think?
- Book Review: "ending Medical Reversal" Is Revolutionary
The take-home message of the first lecture of my first clinical clerkship (Obstetrics and Gynecology) was that we should prescribe supplemental estrogen to all postmenopausal women to prevent cardiovascular disease. That lecture happened in 1999. Less...
- Patients: Steer Clear Of These Six Orthopedic Procedures
After the American Academy of Orthopaedic Surgeons (AAOS) released its Choosing Wisely list, it was criticized for selecting items that are uncommonly used or have little effect on the income of its members. In an editorial in the New England Journal...
- Conservative Medicine: The Big Idea (and Title) Of My Book
A few days ago I was reminiscing about my family medicine residency, where at one of my outpatient training sites I provided care to Amish patients in rural southern Lancaster County, Pennsylvania. The Amish didn't believe in checkups and rarely visited...
- Book Review: "your Medical Mind" And The Challenge Of Shared Decision-making
Recently, I had a conversation with Shannon Brownlee (the widely respected science journalist and acting director of the Health Policy Program at the New America Foundation) about whether men should continue to have access to the PSA test for prostate...
- The Presidential Physical
Based on standards set by the U.S. Preventive Services Task Force (USPSTF), the widely respected independent committee of primary care health professionals that for more than 25 years has rigorously reviewed the evidence for benefits of clinical preventive...