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Efforts to curb unnecessary care are under way, but face well-funded opposition

mri scanner
REUTERS/Jean-Paul Pelissier
The prevailing "more is better" paradigm in medical treatment leads to wasted resources and is in many cases dangerous to patients.

Public efforts to debunk the prevailing “more is better” attitude about medical care tend to elicit scare-mongering charges of rationing. But futile and unnecessary medical care is a major health issue — one that affects all of us.

Fortunately, some people are trying to do something about it. On Tuesday, the journal BMJ published a news feature on those efforts, led by many prominent doctors in the United States, Canada and Great Britain.

As reporter Jeanne Lenzer points out, overtreatment is both costly and deadly. “Overly aggressive treatment is estimated to cause 30,000 deaths among Medicare recipients alone each year,” she writes. “Overall, unnecessary interventions are estimated to account for 10-30% of spending on healthcare in the US.” That adds up to $250 billion to $800 billion annually.

In her article, Lenzer summarizes the discussions that occurred at a two-day conference last April in Cambridge, Mass., the first-ever medical meeting in the U.S. to focus exclusively on “avoiding avoidable care”:

The group identified multiple reasons that clinicians and hospitals overtreat, including malpractice fears, supply driven demand, knowledge gaps, biased research, profit seeking, patient demand, and financial conflicts of guideline writers. Other commonly cited problems included the rapid uptake of unproved technology and the failure to inform patients fully of the potential harms of elective treatments. …

Several speakers emphasized the way physicians are paid and trained n the US as central factors. [Dr. Diane Meier, who won a MacArthur “genius grant’ in 2008 for her work in palliative care,] told the BMJ, “Medical students are taught to do things, not how to know what not to do. Medicine is a very action based profession, and that’s how physicians in the US are paid, perhaps not coincidentally. You don’t get paid for telling people that watching and waiting might be best, or that keeping someone comfortable might be better.” The result is that overtreatment is woven through American medical culture — as one participant said, “It’s in the air we breathe.”

Growing public awareness

The recent global downturn and the ever-rising (and unsustainable) cost of health care have begun to awaken the American public about the harms of overtreatment, Lenzer writes. But physicians and others who want to change the “more is better” general attitude toward health care in the U.S. are up against some hefty — and well-funded — opposition. 

[A]s these initiatives begin to move forward and join forces, they will face formidable challenges from the healthcare industry and the general public. Certainly this has been the case in the past. In 2000, Citizens for Better Medicare spent over $65m on a television advertisement opposing President Clinton’s proposed Medicare prescription drug benefit plan. The ad featured “Flo,” an arthritic bowler who claimed she wanted “big government out of my medicine cabinet.” Citizens for Better Medicare turned out to be a front group for the drug industry, which opposed price controls. More recently, patient groups, many of which are heavily funded by industry, have denounced independent evidence based screening guidelines, suggesting that they constitute “rationing” and the work of government “death panels.”

Some specialty professional societies and doctors’ groups also claim that rationing is just around the corner. AmericanDoctors4Truth sponsored a television advertisement in which President Obama pushes an elderly grandmother in a wheelchair off a cliff rather than allow her to have a pacemaker. Earlier this year, the American Urological Association protested guidelines against routine prostate cancer screening, saying that it might “save money in the short term,” but would ultimately cost lives.

The overtreatment movement will have to respond to inevitable charges of rationing, but Meier vigorously opposes the use of the word. “Rationing means that you are limiting necessary care. What we are proposing is limiting unnecessary care — harmful care.”

Unfortunately, this is yet another article with broad public appeal that the BMJ has put behind a paywall. Let’s hope they loosen that policy soon.

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