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The Medical Professionalism Blog

The Sounds of Overtreatment

Most agree something needs to be done about the costs of our health care system for it to remain sustainable.

According to Peter Orszag, formerly of the Congressional Budget Office, the long-term fiscal balance of the United States will be determined by the future of the rate of growth of health care services.  Government spending on Medicare and Medicaid will increase from 5% of GDP today to about 20% by 2050 – the size of the entire federal budget.

While there’s been a lot of talk about rationing as a measure to control costs, several brave souls are taking a different tack and beginning to write about the ill effects of overtreatment.  To them, it’s not “rationing,” it’s about eliminating procedures and tests where the harm to the patient exceeds the potential benefit.

In 2007, Shannon Brownlee, a former journalist who is now at the New America Foundation, published Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer. Brownlee questions how and why procedures, like CT scans and surgery for back pain, have become routine to patients and physicians when they so often offer no benefit — and sometimes even harm — patients at a staggering cost.

In 2010, Rosemary Gibson, long-time national leader at the Robert Wood Johnson Foundation, wrote The Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health and What You Can Do to Prevent It with World Bank economist Janardan Prasad Singh.  In it, they assert that too many unnecessary tests and procedures are performed that do more harm than benefit to patients. They argue that more informed patients have repeatedly been shown to make decisions that reduce overtreatment.  Some estimate that 20-40% of care can be removed without affecting quality or health care outcomes.

Researchers at the National Cancer Institute estimate an excess of 29,000 cancer cases and 15,000 deaths annually because of CT scans, two-thirds of them among women.  In a recent blog post, Bob Wachter pointed to an astounding statistic from a study in the Archives of Internal Medicine done by Rebecca Smith-Bindman at UCSF, a professor of radiology, epidemiology and ob/gyn and national expert in the risks of radiographs:

An estimated 1 in 270 women who underwent CT coronary angiography at age 40 will develop cancer from that CT scan.

And in his recent piece in The New York Times, “Treat the Patient, Not the CT Scan,” Stanford School of Medicine professor Anthony Verghese pointed out, “Imaging tests are now responsible for half of the overall radiation Americans are exposed to, compared with about 15 percent in 1980.”

With each book, article and blog post, the drum beats a little louder.  In all fairness, these statistics are disputed and some worry that these types of numbers will scare away appropriate candidates.  But we’re at a point when these statistics can no longer be ignored.

Many have been in denial of this problem, while others have already stepped up to the plate. Let’s start an honest conversation about overtreatment, the profession’s role in it and what steps we need to take to address this issue.

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