That's a point underscored by Michael LeFevre, professor and vice chair of the University of Missouri's department of family and community medicine and co-chair of the U.S. Preventive Services Task Force, which issues recommendations on testing for preventive health.
"All medical care has harm," LeFevre says, noting the risks inherent in any procedure or medication, which may cause adverse reactions including death.
On a macro level, the widespread provision of antibiotics has led to crises surrounding the evolution of drug-resistant bacteria and consequent calls for conservative use by the U.S. Centers for Disease Control and Prevention and others.
[Read Beyond Gonorrhea: Drug-Resistant Bugs Pose Growing Danger.]
"Physicians have the same ethical obligation to avoid unnecessary care as we do to provide necessary care," LeFevre says. But the less-is-more sensibility does not yet inform American medicine, he explains. "Nobody ever comes in in the morning and criticizes their attending because they ordered too much stuff."
That's due in part to the fee-for-service system, which rewards doctors for ordering tests, and also fears of malpractice. But the system is beginning to change, said Cassel, who hopes that the new standards will serve to protect doctors from lawsuits.
But what about the patients? Will these recommendations against various tests stand in the way of their particular care?
"Every individual deserves a precise and unique approach, so anytime you have a blanket policy, that's not a good thing. But for the most part, these things have strong evidence that they're not helping people," says Eric Topol, a cardiologist at San Diego-based Scripps Health and author of The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. "It doesn't say anywhere, 'don't do for anyone.'"
Furthermore, the campaign's effort to empower the consumer marks much-needed progress, he says. "That's a first. There was never the voice of the patient. It was always the doctor, doctor, doctor," he says.
While Topol applauds the campaign, he stresses that much more needs to happen to effect these changes. Everyone ought to have these recommendations at their fingertips—literally programmed into their smartphones, he says.
[See In Pictures: 11 Health Habits That Will Help You Live to 100.]
Already, health care systems such as Kaiser Permanente, are helping promote the campaign, Cassel says, noting that Choosing Wisely recently received a $2.5 million grant for continued regional outreach from the Robert Wood Johnson Foundation, which funds public health programs. "The message is not so much 'Never do this' as it is 'Let's talk about this,'" says Susan Mende, senior program officer of the RWJF. "Choosing Wisely provides a platform for providers and patients to have conversations about avoiding unnecessary care and changing the paradigm from more care is always better care to the right care is better care."
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