Op-Ed: The Epidemic of Excess Medical Treatment
My recent book, Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care, ignited a national conversation about finding good medical care in the U.S. But a second important theme has spawned out of the debate: Over-treatment in America.
Yet another recent study challenges the benefit of a common medication (beta blockers). This study, published in the Journal of the American Medical Association, follows a series of new studies in top medical journals upheaving historic recommendations by the medical community.
The decades-old broad recommendation for healthy people to take an aspirin a day—reversed. The recommendation for men to have a prostate screening test—reversed. The recommendation for women under 65 to have a bone scan—reversed. And the list goes on.
The reversal of so many medical recommendations by new research tells us one thing: we overdid it. Stepping back and looking at healthcare as a whole, the estimates in a recent Institute of Medicine report make sense: 30 percent of all healthcare is unnecessary. Imagine the potential to address rising healthcare costs by addressing this problem.
Respected institutions like the Institute of Medicine are one thing, but what do doctors think? In doing our own research at Johns Hopkins, my team, lead by medical student Heather Lyu, summarized the current research on over-treatment as identified by practicing doctors within their own specialty. Here’s what we found: specialists identify unnecessary medical care in their own field to be:
• 20 percent of blood transfusions are unnecessary (journal Transfusion)
• 47 percent of PAP smears are unnecessary (Annals of Internal Medicine)
• 54 percent of prostate treatments are unnecessary (journal Cancer)
• 12 percent of heart stents are unnecessary (Journal of the American Medical Association)
• 23 percent of cardiac defibrillators are unnecessary (JAMA)
• 44 percent of back surgery referrals are unnecessary (journal Radiology)
• 15 percent of thyroid operations are unnecessary (New England Journal of Medicine)
• 51 percent of gollow-up scans are unnecessary (Journal of Clinical Radiology)
While none of these studies are exact (and I myself take issue with some of the methods used), they do, in aggregate, speak to what is endemic in healthcare—over-treatment. In addition, some studies have also found that up to 15 percent of patients are undertreated.
The problem has caught the attention of leading doctors’ groups like the America Board of Internal Medicine Foundation, which has now published a list of overdone tests and procedures in each specialty of medicine. They make these lists available to the public in their “Choosing Wisely” campaign. Thankfully, across the country, doctors and medical organizations are addressing the problem head-on in ways like these.
While there are many proposals to address this epidemic, I believe the best way is to empower patients. If you think modern medicine has some serious problems, then please consider the proposal of transparency as a way to address the problem in a timely fashion.
Do you think over-treatment is a problem with the healthcare system? Let us know in the comments.
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Dr. Marty Makary, a surgeon at Johns Hopkins Hospital, is the author of Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care.