Promoting Evidence-Based Medicine
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?
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 where unnecessary medical procedures are actually damaging to patient health and clarifying the conditions under which 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 review of overused medical practices includes a list of tests and treatments that do not achieve their goals and, in some cases, could actually cause harm. See the press release for a description of the overused procedures.
While the use of stents has reduced, they are still overused despite mounting evidence to the contrary. For example, a recent 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 once their efficacy was shown to be poor.
The bottom line is that each person must take responsibility for his or her healthcare, and do a bit of 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!
Media coverage, resources and research articles
Journal of the American Medical Association (JAMA) Internal Medicine series publication introduction: Less is More
To review articles in the JAMA series, type in “Less is More” in the search term line at the top.
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.
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.
2017 update on medical overuse. A systematic review. Morgan et al., 2017. JAMA Internal Medicine Less is More series.
Clinicians’ expectations of the benefits and harms of treatments, screening, and tests: A systematic review. Hoffman & Mar, 2017. JAMA Internal Medicine Less is More series.
A decade of reversal: An analysis of 146 contradicted medical practices. Prasad et al., 2013. Mayo Clinic Proceedings. Includes table listing the 146 medical practices with efficacy reversed by later research.
Over 150 potentially low-value health care practices: an Australian study. Elshaug et al., 2012. The Medical Journal of Australia.
Note: Parsemus Foundation made an unrestricted gift to support “Less is More” activities and has no financial interest and no editorial control over the series.