Newsweek Cover Story: Less Is More

The most recent Newsweek cover story, “One Word Can Save Your Life: No!”, highlights research showing how some expensive tests and procedures end up doing more harm than good for patients.  Below are highlights from the article:

  • Dr. Stephen Smith, Professor emeritus of family medicine at Brown University School of Medicine, tells his physician not to order a PSA blood test for prostate cancer or an annual electrocardiogram to screen for heart irregularities, since neither test has been shown to save lives.
  • These physicians are not anti-medicine…They are applying to their personal lives a message they have become increasingly vocal about in their roles as biomedical researchers and doctors: more health care often means worse health. “There are many areas of medicine where not testing, not imaging, and not treating actually result in better health outcomes,” Redberg says. In other words, “less is more.”
  • That less health care can lead to better health and, conversely, that more health care can harm health, runs counter to most patients’ conviction that screenings and treatments are inherently beneficial. That belief is fueled by the flood of new technologies and drugs that have reached the market in the past two or three decades, promising to prevent disease and extend life.
  • Patients can easily be fooled when a screening test detects, or an intervention treats, an abnormality, and their health improves, says cardiologist Michael Lauer of the National Heart, Lung, and Blood Institute. In fact, says Lauer, that abnormality may not have been the cause of the problem or a threat to future health: “All you’ve done is misclassify someone with no disease as having disease.”
  • The dilemma, say a growing number of physicians and expert medical panels, is that some of this same health care that helps certain patients can, when offered to everyone else, be useless or even detrimental. Some of the most disturbing examples involve cardiology.
  • Every study found that the surgical procedures didn’t improve survival rates or quality of life more than noninvasive treatments including drugs (beta blockers, cholesterol-lowering statins, and aspirin), exercise, and a healthy diet. They were, however, far more expensive: stenting costs Medicare more than $1.6 billion a year.
  • It turns out that the big blockages that show up on CT scans and other imaging, and that were long assumed to cause heart attacks, usually don’t—but treating them can. That’s because when you disrupt these blockages through surgery, you “spray a whole lot of debris down into the tiny blood vessels, which can trigger a heart attack or stroke,” says Nortin Hadler, a professor of medicine at the University of North Carolina.
  • In a recent study, John McEvoy, a heart specialist at Johns Hopkins Medical Institutions, and colleagues found that 1,000 low-risk patients who had CT angiography had no fewer heart attacks or deaths over the next 18 months than 1,000 patients who did not undergo the screening. But they did have more drugs, tests, and invasive procedures such as stenting, all of which carry a risk of side effects, surgical complications, and even death.
  • Medical practice also suffers from a kind of mission creep: if a treatment works in severe disease, some doctors assume it will work in milder disease. But that is not necessarily so. Antidepressants, for instance, have been shown in randomized trials to help with severe depression but not with moderate or mild depression, yet are widely prescribed for those conditions.

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