By John Schappi
"Less is more" is my new mantra. I'm hoping it will result in briefer posts on this blog. Is that possible?
It would be absolutely fantastic if our health care professionals heeded the growing criticism of today's prevailing "more must be better" attitude. Luckily, momentum is growing for a "less is more" approach to reduce unnecessary and potentially harmful "care."
In 2009, when the United States Preventive Service Task Force advised that mammography for women 40-50 probably does more harm than good, the reaction was hostile. What? More is better! Science be damned.
Our medical culture urges "do everything possible," preferably with the highest level of available technology, even when the effort involves probable harm and little hope of benefit.
Less healthcare stirs fears of rationing... of withholding care to save money. Let's not forget that the vast healthcare machinery—with doctors right there in the middle of it all—earns more money with every additional treatment, operation, prescription. It's a powerful Machine of More.
Signs of change
There are signs of a shift, however. Several major medical journals have recently dedicated special sections that address the harms of over-treatment.
In April 2010, JAMA Internal Medicine launched such a "Less is More" series. To date, it has published over 170 related articles, including research reports, perspectives from patients and clinicians, and commentaries. Similarly, BMJ (originally the British Medical Journal) launched a "Too Much Medicine" campaign and sponsored a conference focusing on preventing over-diagnosis.
Cost of Current Over-treatment
Researchers estimate that wasted healthcare dollars, including the price tag from overuse of low value services, represent about a third of the nation's $2.8 billion health care bill. Even though America spends more health care money per person than any other nation, we rank last compared with 10 other high-income countries in terms of infant mortality, mortality from conditions amenable to treatment, and healthy life expectancy at age 60.
Choosing Wisely Campaign
The "less is more" movement gained traction with the 2012 launch of the Choosing Wisely campaign by the American Board Of Internal Medicine (ABIM) Foundation. The campaign enlisted clinician groups to help galvanize change by naming an evidence-based top five list of tests and procedures that physicians and patients should question, because they offer little or no benefit and may cause harm.
To date, more than 70 specialty societies have joined the campaign, each offering a top five list. Consumer Reports and other consumer groups have signed on to inform patients that more medicine can be harmful.
Some specialty groups embraced the challenge and, despite likely negative effects on their members' bottom lines, presented top five lists that included services often performed within their own specialty that could be considered low-value. The Society of General Internal Medicine advised against routine annual physicals. The American College of Radiology listed five imaging tests to avoid under certain circumstances, like admission or pre-operative chest x-rays for ambulatory patients without specific findings from physical exams and medical histories.
Over-medication of the elderly
Older people take far too many prescription drugs and over-the-counter (OTC) medications and supplements. With age, we become more sensitive to medications and their side effects. Over 40% of elderly people take at least five medications.
I've been on a "less is more" campaign regarding my pills. I've stopped taking the cholesterol and blood pressure medications I'd taken for years. As for the OTC supplements I used to indulge in, I believe the experts who advise getting adequate nutritients, vitamins, and minerals from food, not pills.
This new "less is more" movement helped in my recent battle with my doctors over my ditching blood pressure pills. I kept citing the 2014 recommendation from health experts to raise the acceptable blood pressure range for people age 60 and older from 140/90 to 150/90, and the growing support for the idea that those of us who are over 80 and haven't any signs of heart issues can stop taking blood pressure meds.
I have here on my desk a recent book with the title Less Medicine, More Health and a New Yorker article with the subtitle "An avalanche of unnecessary medical care is harming patients physically and financially."
But this post is long enough. I'll cover that material later.