America’s Epidemic of Unnecessary Care

Public Opinions about Overdiagnosis: A National Community Survey Abstract Background Despite evidence about the "modern epidemic" of overdiagnosis, and expanding disease definitions that medicalize more people, data are lacking on public views about these issues. Our objective was to measure public perceptions about overdiagnosis and views about financial ties of panels setting disease definitions. Methods We conducted a 15 minute Computer Assisted Telephone Interview with a randomly selected community sample of 500 Australians in January 2014. Findings Our sample was generally representative, but included a higher proportion of females and seniors, typical of similar surveys. Conclusions A small minority of Australians surveyed, including those reporting being screened for prostate or breast cancer, reported being informed of overdiagnosis; most believed people should be informed; and a majority felt it inappropriate that doctors with ties to pharmaceutical companies write disease definitions. Copyright: © 2015 Moynihan et al. Introduction Methods Results

Beware of Shifting Options Within Medicare Plans Photo For millions of older Americans, it is time to sift through the mind-boggling array of Medicare plans. There is an average of 29 drug plans to digest, and about 18 options for Medicare Advantage, the plans delivered through private insurers. Then there are the 10 supplemental plans that cover what traditional Medicare does not. The choices can be paralyzing for anyone, and they can be even more challenging as you age. While no broad-based changes are expected, there could be meaningful shifts within individual plans. “People treat this as a momentous decision but they get scared of it, and the thing that worries me is that they don’t make the changes that they should,” said Joe Baker, president of the Medicare Rights Center in New York. Elizabeth Cooper, a 68-year-old former elementary schoolteacher, weighs her options each year. She is healthy now, but she has a history of skin cancer. So she backed out of that plan during the trial period, and opted for peace of mind.

Carlos Martins: Overuse of medical tests—a new health risk factor? A risk factor is, among other things, an aspect of personal behaviour or lifestyle that, on the basis of epidemiologic evidence, is known to be associated with health related conditions considered important to prevent (1). A new behaviour may be observed in the general population of western countries; a behaviour related to the way patients use medical services with preventive intention and the frequency that they receive medical tests and other screenings. Evidence shows an alarming tendency to overuse preventive health services (2,3). In Portugal, for example, a recent population-based cross-sectional study showed that the majority of Portuguese adults think they should undergo general routine blood and urine tests on an annual basis. Other, even less-recommended screening tests, such as lung X-rays, breast ultrasounds, abdominal ultrasounds, and gynaecological ultrasounds, are deemed necessary by a great proportion of the population (3). Competing interests: None declared. References:

Half Somersault Or Foster Maneuver | A DIY Home Exercise for Vertigo How risk factors drive medical overtreatment – Jeff Wheelwright Most health-conscious people are familiar with the concept of risk factors for disease. We’re too familiar, in fact. A risk factor is like the guest that nobody invited to the party, a spoiler. Though we might feel fine now, our individual risk for (fill in the blank) tells us that our wellbeing might not last. That vague and remote prospect of a stroke or a tumour has taken on a sharply numerical precision, thanks to screening tests that expose and quantify our risk factors. The term stems from the Framingham Heart Study, which began in 1948. Popular now How to build a metaphor to change people’s minds Spornosexuality – how much does it pressure young men? Why is the hotel room a place of such lingering despair? Since no single factor was able to predict the heart attacks that occurred in Framingham, the study designers thought to combine half a dozen of them in what became the first numerical risk calculator, called the Framingham Risk Score. There’s a more fundamental issue. Daily Weekly

Does it matter where you buy a Medigap plan? Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. Send your questions to Phil. John: I’m turning 65 soon. Phil Moeller: Medigap plans provide supplemental coverage for people who have basic Medicare (Parts A and B). So, it doesn’t matter where your Medigap plan is issued. Once you have established residence in Texas, you could try to switch to a Medigap insurer there, but you don’t have to. Asela – Fla.: After Hurricane Maria, my niece in Puerto Rico needs to come to Florida for health reasons. Phil Moeller: Yes. As a reminder, Medicare has extended its annual open enrollment period through the end of the year for people affected by Hurricanes Harvey, Irma and Maria. Anonymous: I’m 50 years old and on disability. Phil Moeller: I am sorry to hear about your problems, and hope things turn up for you.

Less is More: The dangers of too much medicine - Students 4 Best Evidence Posted on January 16, 2015 Tags: Cochrane, cost of care, Healthcare triage, JAMA, less is more, over-diagnosis, overtreatment Key message Many people throughout the world are rightly concerned that they are not getting enough of the quality healthcare they need. Yet, there is also a growing concern that the opposite issue of overtreatment, and too much medicine, is actually causing harm, as well as increasing costs of care. What is the problem? There is good evidence that in some developed countries, particularly in the US, healthcare providers are overtreating. One example of excessive screening is the annual health check-up for otherwise healthy adults. Of course there are numerous examples of screenings that do catch undiagnosed or underdiagnosed health issues, and those benefits are clear to the patient. Here is another recent New York Times article, this time by Aaron E. So how did it get this way? There are many reasons why healthcare providers frequently overtreat. Further Reading

Pro/Con: ‘Unnecessary’ Testing by William Sullivan, DO, JD, Jerome Hoffman, MD, Hemal Kanzaria, MD, Marc Probst, MD & Judith Tintinalli, MD on June 29, 2015 Part of a series. Click here to read Night Shift: Throwing Stones. In March, the Journal of Academic Emergency Medicine published a study entitled ‘Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging’. To address the concerns, and potential distortion, we asked EPM senior editor William Sullivan, DO, JD and editor-in-chief Judith Tintinalli, MD, to explain their concerns with the way this study characterizes “unnecessary” testing. Who Defines “Unnecessary?” Many of the discussion points in Dr. In law, statutory ambiguities can mean the difference between freedom and incarceration. Dr. Dr. When CMS proposed using outcome-based normal CT scans in non-traumatic headaches (one of the potentially “unnecessary” tests cited in Dr. Oops. William Sullivan, DO, JD is an attending emergency physician at St. Don’t Miss the Point Dr.

NHS chief warns one in seven hospital procedures are unnecessary - Home News Sir Bruce Keogh, the medical director of NHS England, was quoted by The Sunday Telegraph as saying he estimated about ten or 15 per cent of treatments should not have been carried out. "The waste is profligate in our system. I don't think we should be ashamed of pointing that out and certainly we shouldn't be ashamed of dealing with it," he said. Read moreNHS deficit rises to £822m in England Research from NHS England suggests that many patients are being diagnosed with conditions they do not actually have, and that one-in-20 hospital admissions are a waste of money. It comes as the NHS tries to make £22 billion of savings over the next five years in line with government targets. According to NHS England, unnecessary operations and medication cost the NHS up to £1.8 billion a year. A report from The King's Fund, a public health charity, notes another common incidence of 'overdiagnosis' as the over-prescribing of antibiotics as a cure for coughs and colds.

The Global Problem With Overdiagnosis and Overtreatment It’s a public health conundrum: Current screening guidelines lead to an overdiagnosis of diseases like cancer, which results in overtreatment for ailments that might never seriously impact a person’s health. We’ve heard the overdiagnosis argument in the U.S. before, especially surrounding breast cancer; in 2009, the United States Preventive Services Task Force recommended against annual breast cancer screening starting at age 40 and instead advised women get mammograms starting at age 50. Now, two new studies published Monday in the medical journal The BMJ highlight the global problem with overtreatment in both breast cancer and heart disease. In a new analysis report, a team of researchers conclude that hypertension is being overtreated in people with mild cases of the disease. “Most doctors feel a little under siege; they see blood pressure rising and weight going up and they want to do something, but they know they have huge headwinds,” says Saini.

We're overdosing on medicine – it's time to embrace life's uncertainty The more we learn about the problem of too much medicine and what’s driving it, the harder it seems to imagine effective solutions. Winding back unnecessary tests and treatments will require a raft of reforms across medical research, education and regulation. But to enable those reforms to take root, we may need to cultivate a fundamental shift in our thinking about the limits of medicine. It’s time to free ourselves from the dangerous fantasy that medical technology can deliver us from the realities of uncertainty, ageing and death. We’re all ill now A growing body of evidence shows that when it comes to health care, we may simply be getting too much of a good thing. Not only are we overusing pills and procedures, we’re creating even more problems with “overdiagnosis” by labelling more and more healthy people with diseases that will never harm them. Screening programs targeting the healthy can detect potentially deadly cancers and extend lives. Fundamental shifts in thinking Rays of hope

Safely Doing Less: A Missing Component of the Patient Safety Dialogue + Author Affiliations The American Academy of Pediatrics Steering Committee on Quality Improvement and Management and the Committee on Hospital Care recently published an updated policy statement on pediatric patient safety in Pediatrics.1 The statement is thorough, and it accurately summarizes salient principles. However, like many discussions surrounding patient safety, a key component of the dialogue is missing from the statement. Although safely doing less might make sense to some physicians, there are many factors that impel us, instead, to do more. To redress this imbalance, we propose including the minimization of overtesting and overtreatment as a core initiative of the patient safety movement. “Just to be safe” is often used as a reason to test and treat our vulnerable children. Footnotes Accepted September 20, 2011. Copyright © 2011 by the American Academy of Pediatrics

Costly and harmful: we need to tame the tsunami of too much medicine ABC’s Four Corners program on waste in health care didn’t pull any punches. “Many common treatments are often unnecessary, ineffective, or worse still harmful,” said presenter Kerry O’Brien, introducing a special investigation narrated by long-time ABC health reporter Dr Norman Swan. “Waste runs into tens of billions of dollars a year – much of it due to overdiagnosis and the ill-advised treatments that follow.” For those who missed it, last night’s program focused on several high-cost areas of health care where the evidence suggests that too much medicine is doing us more harm than good: knee pain, back pain, chest pain and PSA (prostate specific antigen) screening for prostate cancer. The program’s key targets were sophisticated and expensive medical tests – such as computed tomography (CT) scans and magnetic resonance imaging (MRIs) – being ordered in ever greater numbers, often unnecessarily. ‘Fixing’ ageing knees Take knee pain, for example. The knee example gets worse.

Update on Medical Practices That Should Be Questioned in 2015 Importance Overuse of medical care, consisting primarily of overdiagnosis and overtreatment, is a common clinical problem. Objectives To identify and highlight articles published in 2014 that are most likely to influence medical overuse, organized into the categories of overdiagnosis, overtreatment, and methods to avoid overuse, and to review these articles and interpret them for their importance to clinical medicine. Evidence Review A structured review of English-language articles in PubMed published in 2014 and a review of tables of contents of relevant journals to identify potential articles that related to medical overuse in adults. Findings We reviewed 910 articles, of which 440 addressed medical overuse. Conclusions and Relevance Many common medical practices should be reconsidered.