April 19, 2012 | Posted By David Lemberg, M.S., D.C.

Something remarkable is happening in the world of medicine (the field is often considered a monolithic special interest group). On April 4, 2012, nine medical specialty societies released lists of the "Top Five" services that are the most expensive and "have been shown not to provide any meaningful benefit to at least some major categories of patients".1 These nine lists are the first results of the "Choosing Wisely" campaign, launched by the American Board of Internal Medicine in response to a 2010 article in the New England Journal of Medicine.1

That article challenged physicians to take the lead in health care reform. Rather than waiting for the government to impose new standards and regulations, the article encouraged physicians and professional medical societies to identify wasteful services and procedures that could be readily eliminated.

As approximately one-third of the $2.5 trillion spent annually on health care represents unnecessary treatment, huge sums would be saved by reigning in such profligacy. Unnecessary treatment could be slashed immediately without depriving any patient of useful care. The only harm, of course, would be done to physicians' incomes and the balance sheets of global pharmaceutical corporations, medical device companies, and for-profit insurance companies.

Recognizing the ethical opportunity and the importance of immediate action, the Choosing Wisely campaign has boldly stepped to the forefront and is encouraging physicians to take personal responsibility for their methods of practice. Seemingly radical, previously unthinkable steps are being proposed. For example, the American Academy of Family Physicians recommends against ordering imaging for low back pain within the first six weeks, unless red flags are present. As low back pain is the fifth most common reason for all physician visits, this guideline alone would result in substantial savings. Equally remarkably, the American College of Cardiology Choosing Wisely guideline recommends against performing stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present. The ACC guideline notes that asymptomatic low-risk patients account for up to 45% of unnecessary "screening". This is another opportunity for large-scale savings.

The NEJM article challenged the medical profession to put the patient's interest first. The article questioned the ethics of organized medicine and insisted that medicine conduct itself as a profession and not merely as a business. The Choosing Wisely campaign represents an important policy initiative. Bearing in mind that an additional one-third of annual health care expenses goes to administrative costs (the vast majority benefiting private insurers), real health care reform could realistically shave more than $1.5 trillion off the total. Appropriate reform measures, from both the medical profession and the federal government, would return massive sums to the pockets of Americans and restore vibrancy to the national economy. Of course, such reforms would go far toward restoring the public's faith and trust in the medical profession. The advent of renewed trust would in itself be likely to improve outcomes and reduce costs.

1Murray TH: Medicine's ethical responsibility for health care reform - the top five list. NEJM 362:283-285, 2010


The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

0 comments | Topics: Bioethics and Public Policy , Bioethics in the Media , Doctor-Patient Relationships , Health Care Policy , Health Insurance

Add A Comment
(it will not be displayed)

BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.