VIDEO: A troubling pharmaceutical cocktail | Dee Mangin #WalrusTalks

Polypharmacy-smashing superstar Dee Mangin delivered a compelling talk for The Walrus about the problem of too much medicine.

In just over 8 minutes, she beautifully articulates the issue and a vision of how we can address it.

Source: https://www.youtube.com/watch?v=QQkV7yHuQ-...

ATTN: Edmonton, Feb 3, 2016 Picard Lecture: Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

Gilbert Welch (img used without permission,  Beacon Broadside )

Gilbert Welch (img used without permission, Beacon Broadside)

I just learned of this event in Edmonton, on Feb 3rd. Don't miss it!

Welch is a persuasive champion of 'less is more' in medicine, and his talks are inspiring, dynamic, and necessary. If you can't attend, check out his latest book, Less Medicine, More Health. RSVP details below. - J.


From The University of Alberta (original post):

"Many doctors are worried about the problems caused by too much medical care. A recent survey suggested that nearly one-half said their patients received too much medical care. But it is hard to communicate the nuances – that medical care can do a lot of good in selected settings, but can also do harm in others – during a 10-15 minute clinic visit.

Doctors like to blame lawyers for the problem of too much medical care. But ask yourself this: Would the problem of overuse disappear if the lawyers disappeared? Economists like to blame economics. But the recipe of adding fee for service to third-party payment to cook up too much medical care would not work without strong underlying beliefs about the value of the product. The general public harbors assumptions about medical care that encourage overuse.

I’m not blaming the public; many of these assumptions flow directly from information provided to them – be it from the news media, talk shows, advertising, PR campaigns, disease advocacy groups, public service announcements or doctors themselves.

Regardless of their source, these assumptions lead individuals to have an excessively optimistic view of medical care. That leads them to seek – some would say to demand, others to accept – too much care.

February 3, 2016
12:00
McLennan Ross Hall (Rm 231/237), Law Centre (111 - 89 Ave)
University of Alberta - Edmonton, AB

Please RSVP here.

Dr. Welch is a general internist and professor of Medicine at the Dartmouth Institute for Health Policy and Clinical Research in the Geisel School of Medicine. He is also a professor of Public Policy at Dartmouth College and a professor of Business Administration at the Amos Tuck School.

For the 25 years he has been practicing medicine, Dr. Welch has been asking hard questions about his profession. His arguments are frequently counter-intuitive, even heretical, yet have regularly appeared in the country's most prestigious medical journals — Annals of Internal Medicine, Journal of the American Medical Association, the New England Journal of Medicine and the Journal of the National Cancer Institute — as well as in op-eds in the Los Angeles Times and the New York Times. His most recent book is Less Medicine, More Health – 7 Assumptions that Drive Too Much Medical Care.

Dr. Welch is very much part of the “Dartmouth School” that questions the assumption that more medical care is always better. His research has focused on the assumption as it relates to diagnosis: that the best strategy to keep people healthy is early diagnosis – and the earlier the better. He has delineated the side-effects of this strategy: physicians test too often, treat too aggressively and tell too many people that they are sick. Much of his work has focused on overdiagnosis in cancer screening: in particular, screening for melanoma, thyroid, lung, breast and prostate cancer."

A New Kind of Rounds: Type 2 Diabetes in the Elderly CME

Thanks to my local Division of Family Practice and the Practice Support Program (PSP), we were able to put together "A New Kind of Rounds" event all about helping patients find the right amount of medicine. 

Our first event, focussed on Type 2 Diabetes in the Elderly, and specifically the harms of treating this too aggressively. Inspired by the Lown Institute's RightCare Rounds and the DoNoHarm Project, we started with patient cases in which the patient's perspective highlighted the burden of treatment and the potential harms of too much medicine.

After small-group case learning, I presented a didactic session reviewing the unique factors that change our approach to management in the elderly, the best available evidence on diagnosis and treatment targets, the current guidelines, and some resources that clinicians and patients can refer to in order to make shared decisions about the "right amount" of care.

The event was well-attended and it was heartwarming to see the level of engagement on this topic from clinicians in our community; we are reviewing the evaluations to consider some changes to the format. Participants also generated an amazing of possible topics for future events, from hypertension to cancer-screening, and anti-psychotic use in the elderly to the annual physical. 

The slides are available here.

Your feedback is most welcome. You can comment below or e-mail. 

My other lectures can be viewed here.

Source: http://prezi.com/ln78vzbqpu4-/?utm_campaig...

RADIO INTERVIEW: Dr Iona Heath: Too much medicine is making us sick

Dr Iona Heath is one of the foremost voices of the movement that confronts overdiagnosis and medicalization. She is in Australia to deliver a Sydney Ideas talk, "Too Much Medicine: Exploiting Fear for the Pursuit of Profit," on August 5th.

Testament to her ability to draw a crowd as she speaks frankly, humanly, and persuasively about this controversial subject, it has been moved to a larger venue!

While the Sydney Ideas talk may not be made available online, she has also given an interview with ABC Radio Conversations in Australia.

In the discussion, she frames the problem of 'too much medicine' and helps to define the difference between illness and disease, explaining how we make well people into patients.

With reference to A Fortunate Man and drawing on experience and connection with patients from her own 30 years in practice, she speaks about the role of the general practitioner and our inability to address the social determinates of health - the real underlying risk factors for poor health. 

Challenge by an interviewer who is not familiar with the science behind risks and outcomes of screening mammography for breast cancer, Iona emphasizes that the key message is not that a test or treatment is wrong for everyone, but that patients must be given informed choice. They must be fully informed of the potential risk and benefits of any intervention, and think about how it may impact them personally.

When the interviewer sticks to the common rhetoric 'prevention is better than cure' and insists that listeners should not run out and cancel their mammogram, Iona answers this bravely and personally. She shares that she, being in a low risk category, has decided that the harms of a mammogram outweigh the benefit for her. The paper she wrote in the BMJ in 2009, It is not wrong to say no, summarizes the arguments fully.

Iona does not state this explicitly, and I'm not sure it is fair to suggest it is implied, but our professional oath guides us such that: where there is risk but no benefit, the medical expert has a duty not to harm and so will encourage avoidance of the unnecessary test or treatment.

I am hopeful the lecture hall tonight is bursting at the seams with contemplative fence-sitters who may be persuaded by her words. Every event like this brings us closer to transforming the culture of care and being able to improve the lives of our patients.

Source: http://www.abc.net.au/local/stories/2015/0...

CONFERENCE: Preventing Overdiagnosis 2015 #PODC2015

I registered for this year's Preventing Overdiagnosis conference in Bethesda, MD (near Washington, DC).

You should too, before the spots are all filled up! Last year's in Oxford was incredible. Lots of inspiration, intriguing research and practical solutions to solving this problem on a 1:1 or international level.

If you are interested to see what other events are happening around the subject of 'too much medicine,' the 'right amount of care,' and so on, you can see them on the Events section of this site.

Comment here if there is something missing!

See you in Bethesda :)

 

Source: http://www.preventingoverdiagnosis.net/

"#Overdiganosis is in the eye of the beholder" The challenge begins with definition

Stacy Carter headed a great session at the Preventing Overdiagnosis 2014 conference in Oxford, which is where I met her for the first time.

 This BMJ talk Medicine interview expands on that session and on the paper written with Rogers, Heath, Degeling, Doust, and Barratt. They explore the culture (ethical and social aspects) and science behind "overdiagnosis," why it is so hard to define, and limitations of the term.

Listen at the BMJ and read the paper, which I am delighted to report, cites this website!

Source: http://www.bmj.com/content/350/bmj.h869

A summary: How to prevent #overdiagnosis @SwissMedWkly

For anyone who is even remotely interested in the movement to prevent overdiagnosis, I suggest you check out this article, How to Prevent Overdiagnosis, in its entirety.

Dr Arnaud Chiolero et al. have provided a thorough overview of the causes of overdiagnosis, methods to estimate the frequency of overdiagnosis, and interventions to prevent overdiagnosis.

As a teaser, I present to you the summary tables from the article:

We all might argue about the exact contributors to overdiagnosis, but this list (based on a review of the literature) is pretty thorough. Fortunately there is hope to combat the problem, and some specific examples are given:

See the article or follow Dr Chiolero (@swissepi) on Twitter for more.

Source: http://www.smw.ch/content/smw-2015-14060/

Prescribing the end-of-life conversation: Dr A. Volandes

It is a treat to see more and more articles in major publications outlining the need to talk about death and dying. The more we talk about it, the easier it gets.

If doctors (and patients) could see 'not knowing the patient's goals of care' as a problem as in need of urgent solving as 'the right-lower quadrant is tender,' 'the rhythm is v. tach,' or 'the potassium is 1.8' then we would all certainly be better off.

Read Dr Volandes take, subtitled: "Is saving the life of a terminal patient always the best medicine", in the Boston Globe.

Source: http://www.bostonglobe.com/opinion/2015/01...