VIDEO: Wasted: Waste and Harm and Unnecessary Tests (Four Corners)

In just 45 minutes, the problem of overdiagnosis, overtesting, and overtreatment is clearly summarized using examples from the Australian system. The costs and harms to patients are incredible, and an analogy – taking the wrong train and winding up where you never intended – is an effective illustration of the issues.

Some key messages:

Billions of dollars are spent on procedures that are not needed, simply because patients expect them and because doctors continue to lobby to be paid to do their 'favourite' procedures.

What is your estimate of how many of those knee arthroscopies are unnecessary? - Dr Normal Swann, Interviewer
Uh, I would say, at least half. - Dr. Ian Harris, orthopedic surgeon

This is no surprise. Dr James Rickert has been advocating for more appropriate care in orthopaedics, for example with an alternative Choosing Wisely list  (despite what the article says, not just 'one guy's opinion' but rather a summary based on the best available evidence, presented most recently at Preventing Overdiagnosis), for years. But conflict of interest, particularly in industry lobbying and influence in the creation of guidelines, continues to be a problem. So does fee-for-service payment systems which encourage higher throughput rather than best care. 

There are other pressures too:

Often the best medicine is no medicine at all, or the best intervention is no intervention at all. But those conversations with patients that take that time to explain that the evidence simply doesn't support doing a test or prescribing a drug  - are long conversations and it's much easier in clinical practice to do things quickly and prescribe or order a test. - Dr Rachelle Buchbinder, rheumatologist


Patients and physicians are both uncomfortable with uncertainty, so tests 'just to see,' continue to be ordered, despite the evidence that they are needless and carry risks. We need to realign expectations, save the waste, and re-direct it into areas of health care that will really help people instead of harming them.

Watch the video for more cutting commentary and alarming statistics.





Over 150 potentially low-value health care practices: an Australian study

In 2009, the Australian government made announcements supporting an Evidence-Based Medicare Benefits Schedule, building on the initial Quality Framework established in 2010. The project highlighted in this article sought to create and roll-out a clear, open, evidence-based rubric for identifying potentially low-value services in health care.

Limited resources mean that nations cannot escape having to make difficult health care choices. Identifying and reducing the use of low-value care is becoming a priority for an increasing number of jurisdictions. Each recognises that cost savings or cost-neutral changes can be made within existing health budgets by reducing the use of existing services that offer little or no benefit relative to the cost of their public subsidy. This would allow funding to be reallocated to more beneficial or cost-effective services, thus maximising health gain. We share this project as a step towards fulfilling that objective

Read more in the Medical Journal of Australia.

Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices

In Australia, the government has taken many steps to avoid funding ineffective treatments. However, there have been many issues with creating public policy, including lack of evidence for or against many existing interventions.

The term disinvestment in health care is gaining prominence internationally. It relates to the processes of (partially or completely) withdrawing health resources from any existing health care practices, procedures, technologies or pharmaceuticals that are deemed to deliver little or no health gain for their cost, and thus are not efficient health resource allocations. The goal of reducing the use of ineffective technologies or practices has been central to Evidence-Based Medicine (EBM) for well over a decade.

Read more in Aust New Zealand Health Policy via PubMed.