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America’s Epidemic of Unnecessary Care

America’s Epidemic of Unnecessary Care
It was lunchtime before my afternoon surgery clinic, which meant that I was at my desk, eating a ham-and-cheese sandwich and clicking through medical articles. Among those which caught my eye: a British case report on the first 3-D-printed hip implanted in a human being, a Canadian analysis of the rising volume of emergency-room visits by children who have ingested magnets, and a Colorado study finding that the percentage of fatal motor-vehicle accidents involving marijuana had doubled since its commercial distribution became legal. The one that got me thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste. The researchers called it “low-value care.” But, really, it was no-value care. Could pointless medical care really be that widespread? I decided to do a crude check. To my surprise, it appeared that seven of those eight had received unnecessary care. “I said, ‘Are you fucking kidding me?’ Related:  LessIsMoreMed. #Big Picturewittykidneykelsieab

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

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:

"We're Probably A Little Sick" If you're going to play golf with Eddie and his group, you'll need lots of money and some serious cajones. Though many of us like to have a little something riding on a match—maybe a round of drinks in the clubhouse or a $10 nassau to keep things interesting—for Eddie's crew, gambling is something else altogether. Playing at a top country club in Southern California, guys who make up this loose-knit network of 20 or so serious amateur golfers routinely risk as much as $10,000 per man over 18 holes. When a professional athlete or high-roller from Vegas slips into town, wagers can slide into the $40,000-per-round range. As one of the gang puts it over a clubhouse breakfast: "We're probably a little sick. But we're a different breed of people. Roughly 80 percent of male golfers 18 and up gamble when they play, according to a 2013 Golf Digest survey. Generally the stakes are small. The USGA goes on to say that when gambling, the stakes must not be "generally considered excessive."

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

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

Mass Incarceration: The Silence of the Judges by Jed S. Rakoff What Caused the Crime Decline? a report by Oliver Roeder, Lauren-Brooke Eisen, and Julia Bowling, with a foreword by Joseph E. Stiglitz and an executive summary by Inimai Chettiar For too long, too many judges have been too quiet about an evil of which we are a part: the mass incarceration of people in the United States today. It is time that more of us spoke out. The basic facts are not in dispute. Most of the increase in imprisonment has been for nonviolent offenses, such as drug possession. And whom are we locking up? This mass incarceration—which also includes about 800,000 white and Asian males, as well as over 100,000 women (most of whom committed nonviolent offenses)—is the product of statutes that were enacted, beginning in the 1970s, with the twin purposes of lowering crime rates in general and deterring the drug trade in particular. The unavoidable question is whether these laws have succeeded in reducing crime. But is this true? My point is not to criticize the Brennan study.

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.

'Less Is More': The Next Big Thing for Medicine When billionaire-entrepreneur-Dallas Mavericks owner Mark Cuban lobbed a Tweet in early April advising his followers to have their blood tested "for everything available" every 3 months, he probably didn't expect to unleash a Twitterspheric debate on medical overuse. Scores of health journalists and clinicians jumped on this ill-advised tweet, explaining that such overtesting can result in false positives, further testing, unneeded treatment, patient stress, and considerable costs. Although it's unlikely that the furor swayed opinions on either side, it reflects a larger, thoughtful conversation within the healthcare community. That discussion is the "less is more" movement to reduce overuse of "low-value" services such as screening, diagnostic tests, or treatments that are unlikely to help patients and pose risk of harm. Proponents of less-is-more medicine stress that its focus is avoiding harm rather than mere cost-cutting, which consumers fear might reduce access to necessary care.

When disgusting goes viral: Strong negative emotions can push social sharing through the roof Editor’s note: Our friend Alf Hermida has a new book out on social media and its implications, Tell Everyone: Why We Share and Why It Matters. (It actually came out last fall in his resident Canada, but it was only recently released south of the border.) Alf is both an academic (at the University of British Columbia) and a veteran journalist (founding editor of the BBC News website in 1997), which lets him bring a unique perspective. Most people will have heard a version of the story about the rat served instead of chicken. The combination of eating something inappropriate and unsuitable contact with animals is irresistible. Researchers Chip Heath, Chris Bell, and Emily Sternberg decided to test how far people would go in passing on disgusting anecdotes, no matter how far-fetched. There is a science to grossness. Disgust provokes both an intense moral and physiological reaction. The team found that students talked the most about a clip from the notorious cult film Faces of Death.

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 Bow Tie Model of 21st Century Palliative Care | The Exchange | Canadian Virtual Hospice The Bow Tie Model of 21st Century Palliative Care The World Health Organization’s (WHO) definition of palliative care1 has evolved such that the recipient’s illness is no longer required to be deemed incurable. Palliative care is now described as an approach applying to “life-threatening illness”, and “applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life”. This modern definition aims to include patients at a stage in their illness when cure may be unlikely, but not impossible. Despite this evolution in understanding of our specialty, access to palliative care is still hampered by public perception that palliative care is synonymous with dying. Misunderstanding is very understandable given the relatively rapid development of the specialty and the widely varying levels of access to palliative care services across the country. Figure 1 Figure 2 Figure 3 Figure 4 January 2015

Obama picks Marine commander for next chairman of the Joint Chiefs President Obama will nominate Marine Gen. Joseph F. Dunford Jr. to become the next chairman of the Joint Chiefs of Staff, selecting an experienced field commander to guide the United States through familiar insurgent conflicts in Iraq and Afghanistan and new threats from cyberattacks and China’s military rise. U.S. officials said Obama is expected to announce Tuesday that Dunford, the commandant of the U.S. Marine Corps, is his pick to replace Army Gen. The announcement is the second time that Obama, who has sought to overcome the rocky ties with uniformed leaders that characterized the early years of his administration, has picked a senior officer to provide him with military advice. The president will also nominate Air Force General Paul J. “What makes him attractive is that he’s a ground leader, and we’ve still got ground wars going on,” said an administration official, speaking on the condition of anonymity to discuss the selection process. Retired Gen. Sen.

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.

Disease definitions linked to pharmaceutical companies A few weeks ago, ABC Radio aired a frightening item stating one in 10 Australians has “chronic kidney disease”, CKD, and most don’t know they have it. The story prominently featured fear of early death, and the salutary tale of a young man who belatedly discovered advanced kidney disease needing medical attention. What the ABC story didn’t reveal was that the definition of kidney disease has been dramatically and controversially expanded in recent years by experts and organisations with direct links to pharmaceutical companies. The broad new CKD definition arose in 2002 from a partnership between the United States National Kidney Foundation and Amgen, a big drug company. As it happens, many of the people labelled under this definition of “chronic kidney disease” will – bizarrely – never experience any kidney disease. Despite a decade of criticism of this broad definition of CKD, drug-company-funded organisations have strongly defended it.

Gawande looks from doctors and patient's viewpoints with heart-wrenching examples to explore what unnecessary care is, how commonplace it is, the factors that drive it, why it is so hard to recognize and overcome.

"The one that got me thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste.
The researchers called it “low-value care.” But, really, it was no-value care.

. . . The forces that have led to a global epidemic of overtesting, overdiagnosis, and overtreatment are easy to grasp. Doctors get paid for doing more, not less. We’re more afraid of doing too little than of doing too much. And patients often feel the same way. They’re likely to be grateful for the extra test done in the name of “being thorough”—and then for the procedure to address what’s found. . .

It isn’t enough to eliminate unnecessary care. It has to be replaced with necessary care. And that is the hidden harm: unnecessary care often crowds out necessary care, particularly when the necessary care is less remunerative. " by lessismoremed Jun 19

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