Can Hospitals Avoid Waste and Prevent Overtreatment?

U.S. News talks to Nobel Prize winner Dr. Bernard Lown about simplifying medical management.

Dr. Bernard Lown, peace activist and founder of the Lown Cardiovascular Research Foundation in Brookline, Mass., has advocated for reducing waste and overtreatment in American medicine.
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Bernard Lown is a cardiologist, a peace activist and a medical maverick who has earned the respect of his peers for research and innovations in cardiovascular care, despite often being a thorn in their sides. In 1981, he and Russian cardiologist Eugueni Chazov co-founded International Physicians for the Prevention of Nuclear War and in 1985 they were awarded the Nobel Peace Prize. Lown introduced the first direct current cardiac defibrillator to medicine in 1960. He founded the Lown Cardiovascular Research Institute in 1973, where he proved his theory that too many heart disease patients were undergoing surgery when simpler medical management could achieve the same or better results.

[READ: Overtreatment vs. Ending Treatment]

It has always been his conviction that if doctors return to the roots of their profession by spending more time understanding and listening to patients, unnecessary tests, surgeries and procedures would go down, health would improve and costs would be reduced. It's a message that resonates today as health care spending continues to rise unsustainably. When Lown began practicing medicine in 1957, annual health spending per person in America was $157. In 2012, it was estimated to be $8,953.

In 2012, the Lown Institute began to expand its focus to broader issues of waste and overtreatment in medicine and, in December 2013, hosted its second annual conference on the subject. Coincidentally, 2013 marked the first time that nine major physician specialty groups identified five tests or procedures each that they say are commonly used but not always necessary. Additional lists of unnecessary procedures are expected to be published in 2014.

[READ: How Hospitals Are Facing the Future]

U.S. News spoke to Lown, as well as to Dr. Vikas Saini, president of the Lown Institute, about a growing national movement to avoid waste and prevent overtreatment in American medicine.

Dr. Vikas Saini is president of the Lown Institute in Brookline, Mass.

U.S. News: How does the task of tackling waste and overtreatment in the health care system today compare to your efforts in the 1980s to help to pull the world back from the precipice of nuclear war?

Dr. Lown: The challenge we faced then was more difficult. Then, we dealt with Soviet Communism, with a world frightened and paralyzed. We had to stop the Cold War. We mobilized doctors all over the world with the IPPNW in 1981. And four years later, we got the Nobel Peace Prize. What we're doing now is much less difficult. People are supporting our priority. We have to get rid of overtreatment, undertreatment and mistreatment. Those three things have to go.

U.S. News: An early example of overtreatment that you've cited involved the prevailing medical practice of the 1950s of keeping heart attack patients inactive and in bed for four to six weeks. Could you summarize that experience?

Dr. Lown: Bed rest was a form of medieval torture. Strict bed rest promoted depression, bedsores, intractable constipation, phlebitis, lethal pulmonary embolism and much else. Inspired by my mentor, Dr. S. A. Levine, I launched a study in 1951. Patient improvement was striking. In fact, hospital mortality from acute MI's [myocardial infarction, or heart attack] more than halved, depression diminished, pulmonary emboli nearly vanished, hospitalization was markedly shortened, rehabilitation and resumption of work was hastened. I am not aware of a single cardiovascular measure since then that improved survival of [heart disease] patients as much as this common-sense change in medical management. One should mention, if only as a historical footnote, that there was not a scintilla of evidence supporting prolonged bed rest.

U.S. News: That's an example of an abundance of caution that ended up harming patients. What examples of overtreatment related to modern technology have you seen?

Dr. Lown: At the Peter Bent Brigham Hospital [now Brigham and Women's Hospital in Boston] in 1960, I was asked to see a patient who was in her late 70s, demented, and had burns over 60 percent of her body. She had been smoking in bed. They asked me to consult about putting in a pacemaker, which she did not need. Furthermore, she was clearly dying, and implanting a pacemaker would only have increased her suffering without prolonging her life. I was mortified. I wrote a note urging against a pacemaker. It created quite a rumpus. If that were an isolated episode, it would be tragic. But that kind of thing happened daily.


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