Too Much Medicine Happens Too Often

Caverly, Tanner J.; Combs, Brandon; Moriates, Christopher; Shah, Neel; Grady, Deborah

doi:10.1001/jamainternmed.2013.9967

Cited by 27 publications

(10 citation statements)

References 8 publications

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“…A variety of reviews have concluded that harms have been understudied in screening trials (8) and in other studies (9,10), that estimates of studied harms can be biased (11), and that potential harms are underestimated by patients (12). Moreover, harms resulting from possible overdiagnosis and overtreatment in screening are relevant to the discussion of “too much medicine.” (13, www.bmj.com/too-much-medicine). …”

Section: Introductionmentioning

confidence: 99%

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Harms of cervical cancer screening in the United States and the Netherlands

Habbema

Weinmann

Arbyn

et al. 2017

Intl Journal of Cancer

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We studied harms related to cervical cancer screening and management of screen-positive women in the United States (US) and the Netherlands. We utilised data from four US integrated health care systems (SEARCH), the US National Health Interview Survey, New Mexico state, the Netherlands national histopathology registry, and included studies on adverse health effects of cervical screening. We compared the number of Papanicolaou (Pap) smear tests, abnormal test results, punch biopsies, treatments, health problems (anxiety, pain, bleeding, and discharge), and preterm births associated with excisional treatments. Results were age-standardized to the 2007 US population. Based on SEARCH, an estimated 36 million Pap tests were performed in 2007 for 91 million US women aged 21–65 years, leading to 2.3 million abnormal Pap tests, 1.5 million punch biopsies, 0.3 million treatments for precancerous lesions, 5 thousand preterm births, and over 8 million health problems. Under Netherlands screening practice, fewer Pap tests (58%), abnormal test results (64%), punch biopsies (75%), treatment procedures (40%), preterm births (60%), and health problems (63%) would have occurred. The SEARCH data did not differ much from other US data for 2007 or from more recent data up to 2013. Thus compared with the less intensive screening practice in the Netherlands, US practice of cervical cancer screening may have resulted in two- to three-fold higher harms, while the effects on cervical cancer incidence and mortality are similar. The results are also of high relevance in making recommendations for HPV screening. Systematic collection of harms data is needed for monitoring and for better incorporation of harms in making screening recommendations.

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Section: Introductionmentioning

confidence: 99%

“…12 Moreover, harms resulting from possible overdiagnosis and overtreatment in screening are relevant to the discussion of "too much medicine" (Ref. 13, www.bmj.com/too-much-medicine).…”

Section: Introductionmentioning

confidence: 99%

Harms of cervical cancer screening in the United States and the Netherlands

Habbema

Weinmann

Arbyn

et al. 2017

Intl Journal of Cancer

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“…Other observations are equally thought provoking: "Do as much as possible for the patient and as little as possible to the patient [42]; Medicine is science of uncertainty and art of probability: ironically only uncertainty is a sure thing, certainty is an illusion [43]. Three recently published books contain similar perspectives and detailed data [44][45][46].…”

Section: Defensive Medicine and Overdiagnosis: Resurgence Of Errors Omentioning

confidence: 99%

Medical errors, malpractice, and defensive medicine: an ill-fated triad

Berlin

2017

Diagnosis

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For the first 180 years following the founding of the US, physicians occasionally were sued for medical malpractice. Allegations of negligence were errors of commission -i.e. the physician made a mistake by doing something wrong, usually mistreatment of a fracture or dislocation, a complication or death following a surgical procedure, prescribing the wrong medication, and after the discovery of the X-ray by Roentgen in 1895, causing radiation burns. In the mid twentieth century malpractice allegations slowly changed from errors of commission to errors of omission -i.e. the physician failed to do something right: almost always, failed to make a diagnosis. The number of malpractice lawsuits increased at a geometric rate beginning in the 1960s, and in the 1970s physicians began practicing defensive medicine, which lead physicians to order unnecessary radiology exams and tests. In the past 20 years the number of malpractice lawsuits has been decreasing, but the practice of defensive medicine has continued. Unnecessary exams and tests increase the likelihood of overdiagnosis and overtreatment, i.e. a new kind of error of commission.

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“…37 Similarly educators and administrators at Icahn School of Medicine at Mount Sinai developed the “OCCAMs Conference” that employs root cause analysis to frame cases of overuse as medical errors and mobilizes the trainee audience to brainstorm solutions and participate in improvement projects to prevent similar overuse events. 38 JAMA Internal Medicine has further engaged trainees through the Teachable Moments series in which students and trainees publish cases of overuse that led to harm, 39 with over 55 such cases published by the end of 2017.…”

Section: Tell Storiesmentioning

confidence: 99%