Promoting Evidence-Based Medicine
Summary: Some doctors still prescribe unnecessary medical procedures and medications. These resources can help you make informed medical decisions.
Less is More
Medical treatments, each with their own set of side effects, often continue to be used even after data has shown that they do not improve outcomes in certain situations. The reasons are many and include systematic profit structures, lack of awareness, or simply the understandable desire to “do something” for the patient. How to address this?
The Parsemus Foundation helped make possible a series called “Less is More,” running 2010-2011 in the Archives of Internal Medicine (now called the Journal of the American Medical Association Internal Medicine), a journal that goes to primary care physicians all over the country. This series highlighted cases in which unnecessary medical procedures have actually damaged patient health, and clarified the conditions under which certain procedures and drugs are best used. Angioplasty and stenting were covered in the original series, as well as data on colonoscopy frequency, proton pump inhibitors, and more.
Due to the popularity of the “Less is More” series, it has continued to this day. The 2017, 2018, and 2019 reviews of overused medical practices described tests and treatments that do not achieve their goals and, in some cases, could actually cause harm.
While the use of stents has declined, they are still overused despite mounting evidence against them. For example, a 2017 study showed no impact on chest pain after implantation of a stent to open a blocked artery. A February 2017 article in The Atlantic highlighted the continuing overuse of certain medical treatments, including stents. The authors noted that doctors are often quick to adopt new procedures, even with shaky evidence, but it may take ten or more years for them to stop prescribing something once its efficacy is shown to be poor.
Other points made in the reviews:
- Electrocardiograms are routinely performed on low-risk patients
- Lipid monitoring rarely affects care
- Overdiagnosis of cancer caused anxiety and criticism about not seeking treatment
- Calcium and vitamin D supplementation does not reduce hip fracture
- Pregabalin does not improve symptoms of sciatica but frequently has adverse effects
- and more…
The bottom line is that each person should take responsibility for his or her healthcare, and do some research before accepting a medical procedure or medication. The Choosing Wisely lists are a good place to start. Your extra effort just might save your life!
Journal of the American Medical Association (JAMA) Internal Medicine series publication introduction: Less is More
To review articles in the JAMA series, enter “Less is More” in the search box at the top.
Choosing wisely. Lists of evidence-based recommendations for various health conditions from medical specialty societies summarized by Consumer Reports. An initiative of the ABIM Foundation.
Why Doctors Still Offer Treatments That May Not Help. Austin Frakt, Aug. 26, 2019, New York Times.
Slow Medicine: Overuse of Genetic Testing, Dialysis. Michael Hochman, MPH, MD, and Pieter Cohen MD, Sept. 14, 2018, MedPage Today.
When evidence says no, but doctors say yes. David Epstein and Propublica, Feb. 22, 2017, The Atlantic.
Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D. (2019). 2018 Update on medical overuse. JAMA Intern Med. 1;179(2):240-246. (abstract)
Morgan DJ, Dhruva SS, Coon ER, et al. (2018). 2017 Update on Medical Overuse: A Systematic Review. JAMA Intern Med. 178(1):110-115. (abstract)
Hoffman TC, Del Mar C. (2017). Clinicians’ expectations of the benefits and harms of treatments, screening, and tests: A systematic review. JAMA Intern Med. 177(3):407-419. (abstract)
Prasad V, Vandross A, Toomey C, et al. (2013). A decade of reversal: an analysis of 146 contradicted medical practices. Mayo Clin Proc. 88(8):790-798. (free full text)
Elshaug AG, Watt AM, Mundy L, Willis CD. (2012). Over 150 potentially low-value health care practices: an Australian study. Med J Aust.197 (10): 556-560. (free full text)
Note: The Parsemus Foundation made an unrestricted gift to support “Less is More” activities, and has no financial interest and no editorial control over the series.