Re: Negative treatments… changing our words to drive deprescribing

Abstract

To the Editor: We appreciate the author's thoughtful perspective on deprescribing harmful and unnecessarily costly medications among older adults. 1 The term lowvalue prescribing is derived from the overarching concept of low-value care, which describes the use of any health service whose harms or costs typically outweigh its potential benefits. 2,3 We agree that there are frequently negative treatment effects that stem from low-value prescribing and the provision of low-value care more broadly. However, we respectfully favor the term lowvalue prescribing in the context of our paper, as we feel it more adequately reflects the broad tradeoffs between the costs and harms versus the potential benefits that clinicians must consider when prescribing medications to older adults. 4 For example, the use of a low-value medication may afford a patient some benefits, even though those benefits are balanced by the potential risks or excess costs. If a patient and the prescribing clinician arrived a mutual understanding to use this medication aware of the tradeoffs, then I would not consider this a negative treatment. However, alternative terminology that emphasizes the harms caused by the use of specific medications among older adults may be more appropriate in certain circumstances. While there are differing opinions as to the most appropriate verbiage used to describe the use of such inappropriate medications, we agree on the importance of elevating deprescribing as a routine component of care among older adults. ACKNOWLEDGMENTSI affirm that no other individuals have significantly contributed to this work to be listed as authors.