Smarter medicine: do physicians need political pressure to eliminate useless interventions?

Jm Gaspoz

doi:10.4414/smw.2015.14125

Abstract

Echoing the "less is more" and "choosing wisely" campaigns in the USA, the "smarter medicine" campaign launched in 2014 by the Swiss Society of General Internal Medicine listed five tests or treatments that are often prescribed in ambulatory general internal medicine, but that may not provide any meaningful benefit and may carry the risk of generating harms and costs. In the United Kingdom, the National Institute for Health and Care Excellence (NICE) supported the National Health Services in identifying "low value" activities that should be stopped. Political pressure and stringent regulatory measures for pharmaceuticals and medical technology triggered major controversy and opposition. NICE efforts now concentrate on editing guidelines based on consensus techniques, which integrate the evidence from systematic reviews with social values and patient preferences. To obtain significant changes and promote the paradigm of reducing unnecessary waste of medical resources, opinion leaders and leading scientific or academic institutions, as well as medical societies, can make a difference, together with consumer associations and the lay press. Politicians can undoubtedly contribute to the success of these strategies, but rather than putting physicians alone under pressure and setting up stringent regulatory measures, they should network with all stakeholders and put emphasis on a broader agenda, the one of improving healthcare quality and efficiency.

Highlights

Politicians can undoubtedly contribute to the success of these strategies, but rather than putting physicians alone under pressure and setting up stringent regulatory measures, they should network with all stakeholders and put emphasis on a broader agenda, the one of improving healthcare quality and efficiency
It listed five tests or treatments that are often prescribed in ambulatory general internal medicine, but that may not provide any meaningful benefit for at least some patients and that may carry the risk of generating harms and costs [1]
The National Institute for Health and Care Excellence (NICE) experience demonstrates that, as elsewhere in the world [11], too much political, technocratic or administrative pressure may endanger strategies aimed at reducing unnecessary medical tests or procedures

Summary

Echoing the “less is more” and “choosing wisely” campaigns in the USA, the “smarter medicine” campaign launched in 2014 by the Swiss Society of General Internal Medicine listed five tests or treatments that are often prescribed in ambulatory general internal medicine, but that may not provide any meaningful benefit and may carry the risk of generating harms and costs. Political pressure and stringent regulatory measures for pharmaceuticals and medical technology triggered major controversy and opposition. It is difficult to find a precise date or a starting point for the concept that some medical strategies may have no added value for patients, but rather may harm them and waste medical resources. Came the “choosing wisely” campaign in the USA, launched in 2012 and built on the efforts developed since 2009 by the National Physicians Alliance, funded by the American Board of Internal Medicine Foundation. The Alliance guided representatives from three primary care specialists to develop “top five” lists of achievable changes in medical practice that might reduce risks and, possibly, costs [5]. Much less known is the “disinvestment” strategy started in 1999 in the United Kingdom by the National Institute for Health and Care Ex-

The history of Smarter Medicine

The incentives and the actors

Findings

Conclusions