Are You Getting Too Much Medical Care?
First, do no harm—that’s what medical students are taught. Yet unnecessary drugs and tests, along with overly broad definitions of health conditions, can set you up for unexpected damage.
More, December/January 2014
A shift in the frequency of Pap tests is only one small facet of a remarkable change taking place in the medical world. This new way of thinking contends that our medical system’s “more is better” mind-set has saddled healthy people with costly treatments that might actually hurt them, says Fiona Godlee, MD, editor-in-chief of the BMJ (formerly the British Medical Journal), a professional publication that’s leading the charge toward a risk-benefit approach to health care. As part of its Too Much Medicine campaign, the BMJ has presented a series of articles outlining how certain conditions, including osteoporosis, dementia, high cholesterol and breast cancer, are being overdiagnosed and overtreated by doctors.
Take osteoporosis. A study published in the BMJ in 2008 calculated that to prevent one woman from developing fractured vertebrae, 270 women with preosteoporosis would need to take osteoporosis drugs for three years. Two out of three of the vertebrae fractures prevented would not have caused symptoms or reduced the patient’s quality of life. So one woman would avoid a consequential fracture in her vertebrae, and the 269 other women would get no measurable benefit but would subject themselves to potential side effects such as diarrhea, an increased stroke risk, gastrointestinal troubles and a rare but very serious problem called osteonecrosis of the jaw, which causes the bone in the jaw to die.
Medical societies are another part of the “more isn’t necessarily better” movement. The ABIM Foundation created the Choosing Wisely campaign, for which 30 physician-specialty societies, such as the American Academy of Family Physicians (AAFP), each developed a list of actions doctors and patients should question. The AAFP list, for instance, includes “Don’t require a pelvic exam or other physical exam to prescribe oral contraceptive medications.” (For more examples, see “Are You Being Overtreated?”. Find each specialty’s Choosing Wisely list atchoosingwisely.org.) The lists are intended to spur conversations between doctors and patients so that together they can choose the most appropriate and necessary treatments.