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Too Much Medicine Is Bad For Our Health : Page 2 of 2

Too Much Medicine Is Bad For Our Health : Page 2 of 2

•Recognize that all existing medical guidelines that define disease thresholds and make treatment recommendations are suspect. They have been developed by experts in each field who always have an intellectual conflict of interest (and often enough also have a financial conflict of interest) that biases them toward overdiagnosis and overtreatment in their pet area of research interest. New diagnostic standards are as dangerous as new drugs and need the same careful and independent vetting to tame unrealistic diagnostic enthusiasm.

•Employers, insurance companies, and government payors should be smarter consumers of health services and should stop paying for tests and treatments that do more harm than good and are not cost effective.

•Consumers should be smarter consumers and not buy into the idea that more is always better.

•Medical journals need to be more sceptical of the medical research enterprise and should look toward the harms, not just the potentials, of each new purported advance. They should stop drum beating each new study as if it is another big step toward the cure for cancer—which has proven more elusive than anyone imagined.

•The media needs to expose the real harms, not just the imagined wonders, inherent in medical procedures.

•We need to provide more resources to treat the really sick who now often get very inadequate care and at the same time need to protect the really well from getting what is often excessive and harmful care. It is wonderful that medical knowledge and tools have advanced so far, but disheartening that we are so bad at distributing them rationally.

A great deal of progress has already been made. Fifty medical professional associations in the US have seen the need to cut back on inappropriate testing and treatment. Their "Choosing Wisely" initiative is a terrific start in reforming the disaster of our medical non system. The British Medical Journal and Consumer Reports have already played a catalytic role and are powerful platforms for spreading the evidence to physicians and patients.

The participants at the “Preventing Overdiagnosis” conference were 330 policy makers, clinicians, researchers, consumers, medical journal editors, and representatives of several other initiatives also trying to make medical care safer and more rational. Although the US leads the way in wasteful and harmful care, the problem is clearly international—people came to Hanover, NH came from 28 countries.

This is a David versus Goliath struggle. The forces that benefit from massive overdiagnosis can martial hundreds of billions of dollars a year to promote and protect it. The forces supporting rational medical decision making have access to just a few million dollars a year. The smart money is betting on the big bucks and the status quo.

But there is hope. Big Tobacco also seemed impregnable just 25 years ago but was brought down by hard facts and a tiny band of dedicated reformers. Right sometimes does bring might.


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