The majority of Americans must have figured out a while back that President Obama really doesn’t plan to kill Americans (they elected him again, didn’t they?) with his health-reform law.
At least not by the sheer weight of the legislation. (Remember when all the rage in Congress was to raise the almost-3,000-page legislation and hope the heaver didn’t topple over? Just to note: Gov. John Kasich’s new two-year budget reportedly weighs in at a respectable 4,000-plus pages. Killing Ohioans softly with his numbers, you think?)
And not unless the president has co-opted many of the nation’s medical societies, it would appear he isn’t planning to kill Americans, either, by promoting “comparative effectiveness,” studies that would identify medical practices — procedures, tests, devices, drugs and such — that are most efficient in treating illness.
Comparative effectiveness, the fiercest critics of the idea insist, is how you push Americans on the slippery slope to rationing. Bureaucrats are going to come between you and your doctor, waving their research data. They are going to decide what treatment you receive and, ultimately, who lives and who dies. Care is going to be delivered or withheld on the basis of cost, and heaven help you if your treatment is not favored under “Obamacare.”
Fear and distrust about reassessing treatments have been hyped so high, it makes suspect any effort to weed out treatments that owe their survival more to tradition than to their proven effectiveness. But as it happens, growing collaboration among medical societies and consumer organizations — occurring independently of government — is providing a politically neutral platform to address what would be realistic for us as patients to expect in the way of effective treatment from our doctors and hospitals.
Last week, 17 medical specialty associations each offered a list of tests and procedures whose routine use should be questioned. The list of 90 recommendations follows a previous list of 45 recommendations issued by nine other medical societies last April. More such recommendations are due later in the year as part of a national campaign called Choosing Wisely, involving the American Board of Internal Medicine Foundation, numerous medical associations that represent roughly a half-million members, Consumer Reports and consumer advocacy groups.
The partners in Choosing Wisely hope that based on credible evidence, patients and their doctors will be able to hold conversations on which treatments are really necessary, which ones duplicate others with little value added and which ones are likely to cause more harm than good. All this dialoguing, they hope, would lead to “the most effective use of health care resources.”
Among items on the various lists: The American Academy of Pediatrics suggests using CT scans much less often during emergency room visits to evaluate children with minor head injuries. The academy recommends instead clinical observation as a first and effective approach, pointing out the lifetime risks of cancer from X-ray exposure for children. Children younger than 4 years should not be given cough and cold medications for respiratory problems. Why not? Because they offer little benefit and potentially serious side effects, including the risk of accidental overdose.
The American Urological Association’s don’ts include routine bone scans for men with low-risk prostate cancer and testosterone prescriptions for men with erectile dysfunction who have normal testosterone levels.
The American College of Obstetricians and Gynecologists thinks it is not a good idea to induce labor or schedule an elective Caesarean delivery before 39 weeks of gestation unless there is a very good medical reason to do so. Same goes for elective inducements between 39 and 41 weeks. Don’t prescribe antipsychotic drugs as the first option for elderly dementia patients with behavior issues, counsels the American Geriatric Society. The drugs have limited effect, and the potential harms include strokes and premature death.
The premise of Choosing Widely is that good information, presented in language that the average layman can grasp, will lead to intelligent conversation and good decisions about appropriate treatment. The project is appealing as an ongoing exercise in determining what is worth the money in medical care.
It is especially appealing because when the recommendations come from practictioners themselves, it helps to strip a sensitive discussion of the toxic exaggerations so often the currency of the political arena.
Ofobike is the Beacon Journal chief editorial writer. She can be reached at 330-996-3513 or by email at lofobike@the beaconjournal.com