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The Right Prescription
Obamacare’s Medical Mercenaries
In “Choosing Wisely,” they’re replacing the Hippocratic Oath with the ethos of The Hunger Games.
Those who fear Obamacare will be eliminated by an unelected Supreme Court can put down their Xanax: the un-elected American Board of Internal Medicine Foundation (ABIMF) and its un-elected proxies are working hard to get doctors to implement the health law by encouraging them not to diagnose their patients too often. You read that right.
The foundation’s “Choosing Wisely” campaign is framed as a voluntary program to encourage doctors to cut down on “unnecessary medical tests.”
In its “lists” the campaign offers 45 tests to avoid from 9 different medical groups. The selection process is portrayed as the product of deep thinking of leading experts in keeping with the medical edict of first do no harm. Each recommendation begins with the words — much like the Ten Commandments — “do not.” But the definitive tone of denial repudiates the Hippocratic Oath and replaces it with spirit of The Hunger Games.
Indeed, Choosing Wisely is designed to sustain the rationale and ideology that shaped Obamacare. Ruling out any test prior to even seeing a patient is a political edict, not a scientific decision. As one of medicine’s early innovators, William Osler, noted: “Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease. Clinical judgment begins with uncertainty about the underlying causes of symptoms and ruling out conditions requiring even more tests and ineffective treatment.”
Indeed, the “lists” are not the product of evidence-based review of practice and they come with a disclaimer inconsistent with the absolute certainty of their rightness that these statements are not medical claims. That’s a caveat more commonly associated with weight loss informercials than with a physician’s advice. But Choosing Wisely is not about patients exactly. It is part of the ABIMF and the American College of Physicians (ACP) charter designed to help make doctors “better stewards” in the “just and cost effective distribution of finite [medical] resources.” If this rhetoric rings a bell it’s because you have heard it before from environmentalists who justify government killing off oil production while spending billions on a failed solar energy business model as stewardship. It was also used by Garrett Hardin in The Tragedy of the Commons and Obama science adviser John Holdren to justify forced sterilization to save the planet from overconsumption. And, in The Hunger Games, by the Capitol to justify having tributes from each district kill the other until a sole victor remains.
The ABIMF campaign doesn’t promote such measures (though we should be assured that the president’s science adviser thinks such actions are, like Obamacare, constitutional). But it is designed to give the doctor’s seal of approval to Obamacare’s practice guidelines and rationing. And it’s the blueprint for the campaign ABIMF is underwriting to get doctors to change how they practice medicine in order to bring about the Obamacare revolution.
Harold Sox, ACP’s former president, noted: “I hope that we will look back upon [Choosing Wisely’s] publication as a watershed event in medicine.” Sadly it is. Choosing Wisely is the first collective effort on the part of professional medical societies to decide how to practice medicine on the basis of cost first and foremost. The list of thou shall nots is redundant and highly subjective. Out the 45 “don’ts” nearly six are the same (no pre-operative screenings ) and 16 pertain to cardiac imaging. Almost all are discouraged in patients at “low to moderate” chance of getting sicker or dying from a disease or treatment complication. And the list leaves no room for mixed or inaccurate measurements. Someone goes Code Blue because their doctor chose wisely? Oh well. As Katniss Everdeen observed: “It’s easier destroying things than making them.”
Moreover, it reflects political cravenness on the part of its creators who seek not only to promote Obamacare but cash in on it. Consumers Union, the group that puts out Consumer Reports and also supports a government-run health system, is part of this effort. In 2008 it pushed hard for a highly criticized and widely ridiculed system of rating health care quality in terms of how little care was delivered. By allying with ABIMF and ACP to promote Choosing Wisely, Consumers Union can relaunch its early failure with a medical seal of approval and use it to try to boost subscriptions to its newsletters and magazine. The ABIMF is giving cash to the National Physicians Alliance (NPA). Christine Cassell who heads up the ABIMF, is also on NPA’s board along with Rachel DeGolia, director of the Soros-funded Universal Healthcare Action Network. The Bayview Healthcenter in Baltimore, which employs ABIMF board member David Hollander, also received Choosing Wisely dough. Cassell, along with former ACP president Harold Sox, were early advocates of comparative effectiveness research (CER). Sox appointed Cassell to the Institute of Medicine panel that decided how CER should be conducted.
The Choosing Wisely campaign is ultimately led by people who also stand to benefit from Obamacare contracts. Indeed, the closed cabal of docs and consultants who have received CER money in the past from the Agency for Healthcare Research and Quality (AHRQ) and have received most of the (taxpayer) money given out by the so-called Patient-Centered Outcomes Research Institute include ABIMF trustees such as Steven Pauker and Peter Basch (who is also a senior fellow at the virulently anti-Israel Center for American Progress). Richard Baron, an ABIMF trustee, is now a senior official at Health and Human Services, in charge of initiatives worth billions.
Together, CER and Obamacare innovation grants make up the biggest cesspool of single source contracts in government. These dwarf the crony capitalism of the Obama alternative energy program in dollar amount, political correctness, and sheer cronyism. ABIM and ACP are among the first groups to criticize doctors who receive support from drug and medical device companies for training and research. But they have no problem in campaigning for expansion of federal programs they have helped design and benefit from financially and politically.
Most important, Choosing Wisely looks backwards to ration older procedures that are rapidly being replaced by tests that, by identifying which patients respond best to what care, can avoid duplicative or ineffective treatments. Programs such as Horizon Healthcare Innovations’ patient-centered medical homes give doctors more freedom to decide how to treat people and what to test for: the initiative has reduced hospitalization and emergency room use by keeping people healthy.
As Dr. Eric Topol notes in The Creative Destruction Of Medicine about the practice of medicine in general, Choosing Wisely “relies on the wrong concept that the median of patients is the message.” Choosing Wisely is silent on getting doctors to use point of care and hand-held devices that can deliver individualized care frugally, if for no other reason than the insistence that CER be used to determine who has access to such advanced treatment and when. In order to maintain just distribution of medical resources, of course.
Topol notes: “[We] are right at the cusp of having new tools to affect that change — the ability to define each individual in ‘high definition’ at the biological, physiological and anatomical levels. While we have long appreciated that each human being is unique, it is only now that we can leverage this information to improve medicine.” That is truly choosing wisely, something Obamacare’s medical mercenaries have failed to do in forsaking patients for a political agenda.
About the Author
Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.
Appleby| 4.13.12 @ 7:46AM
Obama and the Nomenklatura, Apparatchiks and hangers-on who surround him, and of course the Hated Rich, will be insulated from the consequences of this action. Obama's daughters will never be left for 14 hours in an ER while the people in charge advise him to wait and see if they get better without any treatment. Michelle's mother will not languish in her home being treated by worried relatives because no doctor will commit to treating somebody over 40 because "it's just not worth the money."
And of course Mitt Romney will always be able to jet off to Sweden to have his family's health care attended to immediately.
One more step toward reconstituting the USSR that apparently Obama et al. call "the good old days."
numbatdog| 4.13.12 @ 8:44AM
Correct Appleby,
The political class has already voted themselves out of the medical straightjacket of socialized care.
That gives some idea of how you're going to like it if the creators have jumped ship before it even begins.
What worries me is America is the main driver of medical research. Who will bother with new research when granny gets sent home with an aspirin instead of a new hip?
Von Mises Jr.| 4.13.12 @ 11:35AM
The political class voted us into socialized medicine so that they could have more to steal. They cannot deliver on the entitlement lies and finance their Las Vegas galas, give to their friends and bundlers at Solyndra, and finance Moochelle's vacations while paying for our health care. So buck up and take the pill.
BTW, the reason the political class (such as the leader of Newfoundland) come to America is not because they have to wait for treatment. It is that after 40-60 years of socialzed medicine, they don't have the technology or trained doctors to even save their own Marxist behinds.
Jack in Wi.| 4.13.12 @ 7:54AM
The Hippocratic Oath hasn't meant anything since they changed it after Roe vs. Wade, to take out the part against facilitating and doing abortions.
My uncle by marriage used to run the largestt public charity hospital in this state. He used to tell me how all the best doctors in town would work for free in his charity clinics a day or 2 a week as it was part of their duty under their oaths to help the poor. They also kept up their skills by treating many differnet conditions they did not see in regular practice, very often. It wasn't all bad in the old days and the government stayed out of medicine except at the local level where they provided help to the poor, in providing charity hospitals. Most private hospitals had charity wards as well.
Frank Drackman| 4.13.12 @ 9:59AM
Jack, and I'll make a deal, you don't talk about my wooden penis, I won't talk about the splinters in your tongue...
But as an MD, the Hippocratic Oath hasn't been relevant since, well, Hippo-Crates day.
First of all, it prohibits Doctors from doing Surgery, Giving any Deadly Medications(Coumadin's just repackaged rat poison), or talking about there patients behind there backs..
It even prohibits the Abortion you somehow survived...
Frank
Dick Nome| 4.13.12 @ 10:43AM
Ouch.
Von Mises Jr.| 4.13.12 @ 11:26AM
Frank, Have you noticed how our "Dear Leader" is wasting away? It appears that he is losing substantial weight.
But I then realized that since the Obama's believe in a "zero sum" game; Moochelle found it. Puzzle solved.
Frank Drackman| 4.13.12 @ 11:36AM
I've heard the Co-Cai-ane will do that to you...
Von Mises Jr.| 4.13.12 @ 12:03PM
Or bug juice.
SUBVET| 4.13.12 @ 4:00PM
Maybe Reggie Love gave him something..........
SUBVET| 4.13.12 @ 4:03PM
Oh !!! I know it might be the bathouse blues.......I here the steam room can do wonders.
Von Mises Jr| 4.13.12 @ 9:24PM
If you have a GLBT Czar, one has to wonder?
yuyu| 4.13.12 @ 11:38AM
Yes, Obama is fit and trim. Looks terrific.
And Michelle is looking good also. Fashionable and elegant.
I'm glad I don't have to see the ugly fat asses on this blog. I can tell by your rantings that you are unsightly and toxic to the bone.
Have a good time today, hogs, gobbling up all the slop your extended bellies can hold. Chow down, porkers. Go ahead and pop a heart valve for Jesus!
K & W| 4.13.12 @ 11:41AM
Pop a heart valve for Jesus!
Love it! Best thing I've read today. Keep the hits coming yuyu. These people deserve all the invective you can pile on them.
Frank Drackman| 4.13.12 @ 11:47AM
Fit & Trim? so's Jerry Sandusky.
and I'm 5'9 140, Bee-Yotch. And thats 140 lbs, not Kilos, like that System' Internationale' Fat Ass AlGore.
Yeah, my Driver's license says 5'10' thangs shrink a little with age.
And my ancestors killed Hey-Zeuss, thank you very much.
And speaking of hogs, have you seen Jerry "the Nad" Nadler?
Frank "Gobble THIS" Drackman
yuyu| 4.13.12 @ 12:00PM
I see that the cancer has spread from your swollen prostate to your brain.
Frank Drackman| 4.13.12 @ 12:22PM
At least I have a Brain..
Ewwwwwwwwwwwwww WHAT A BURN!!
and I'll take my Prostrate over your nasty Snatch-age any day, Colustrum Breath.
Frank "Big Un'" Drackman
Aces and Eights| 4.15.12 @ 10:06PM
I'm not sure what the point of your rant is. Michelle Obama is hardly "elegant", and "fashionable" is just another way of saying she wears clothes designed for Hollywood actors and models that others have paid for.
As for "slop", it seems all those happy liberals who live off of taxpayer money are "slopping" it up well and good. "Hogs at the trough" is an apt description of politicians and bureaucrats, and their clients on the dole. Which are you?
One if by land...| 4.13.12 @ 2:42PM
At long last, we agree!
Frank Natoli| 4.13.12 @ 11:34AM
Jack: I usually give your comments the widest possible berth, but this time you're bang on, the vulgar and illiterate witch doctor Drackman notwithstanding.
A man who cannot reason his way to unconditionally protect the most defenseless and the most innocent cannot be trusted, period.
Frank Drackman| 4.13.12 @ 11:41AM
Frank, if that really is your name(its not mine)
I'm sorry if I wounded your fragile sensibilites, if I'd been born a year later, and played teaball instead of dodging 60mph chin music fastballs(not from the other 8 yr olds, my Mom) I'd be a touchy-feely-NPR-listening-probably-cried-during-the-climax-of-"Broke Back, Mounting" P-Word like you...
and sorry, the only movie my old man got teary eyed at was the Zapruder Film, from laughing...
Frank "Trust THIS" Drackman
R| 4.13.12 @ 1:08PM
When it comes to vulgarity, it's hard to top Frank Drakman and so many others who post daily on AmSpec.
Such a pity that they have to lower the tone and make us all look foolish and imbecilic.
Frank Drackman| 4.13.12 @ 1:36PM
Vulgarity?
well X-Skuse me, but if I left a pretty young lass to asphyxiate(NOT Drown, theres a difference)like a certain Dead Kennedy, I'd at least have the common courtesy to call 9-11 instead of huddling with my henchmen to plot my cover story.
OK, not having any henchmen makes it easier, but did he have to continue in Pubic Office for 40 more years and ruin a perfectly good Summer Saturday Afternoon with his stupid funeral
Frank
Frank Natoli| 4.13.12 @ 2:32PM
R: Lower the tone, yes. Make us all look foolish and imbecilic, not unless we foolishly and imbecilically attempt to engage them or play by their rules.
And most encouragingly, they're always on the wrong side! If they came to rational conservative conclusions and articulated themselves like the vulgar and illiterate Drackman, that would be worrisome.
Von Mises Jr| 4.15.12 @ 3:20PM
R and Frankie, get lost. We don't want to talk to liberals. It is a waste of our productive time.
If you are so danm smart, why don't you answer the riddle Perp refuses to attempt. Mises wrote about this in "Epistemological Problems with Economics." I am sure you, a cultured and brilliant liberals, have read this???
Here is goes lame brains:
Riddle me this:
If Marx believed in "Bourgeoisie" economics and "Proletariat" economics; why are you wasting your time talking to the bourgeoisie? Is Marx a fool, or are you? You are like a conch trying to explain your "conch"sciousness to intelligent dolphins.
Perhaps "conch" don't have any logic or consciousness at all?
Mr ED| 4.13.12 @ 8:54AM
It seems obvious and stupid, but the government having an adversarial role in overseeing some industry, healthcare in this instance, is somewhat understandable. The nature of an adversarial role means there are two separate parties who have different viewpoints standing in opposition to one another, and that seems like a reasonable check-and-balance type of relationship that could helps guide an industry - at least in theory - toward better service.
The government being both the provider and the supposed watchdog means the fox is watching the henhouse and that alone is a recipe for disaster. Not that you will hear anything about those disasters because the Leftist Media scum will make sure to sanitise and remove any reference to holy Liberal government having responsibility for any disasters and catastrophes.
I mean hey, what could possibly go wrong?
Gary B| 4.13.12 @ 10:24AM
Mr Ed,
An adversarial situation also means there is only one winner.
LindaF | 4.13.12 @ 9:01AM
Well, one part of a list that makes some sense - use of a spirometer with asthmatics. Self-reports can miss severe conditions, and over-report where there is not a problem.
As I understand it, some of these tests in the population outside of the recommended ages deliver more false positives/false negatives than they catch of correct diagnoses, which makes them both expensive and worthless.
Mark| 4.13.12 @ 9:15AM
FYI:
Dr. Topol's position here seems *vastly* misstated re: the Choosing Wisely campaign. This article's author has taken great liberties, and (I believe) misrepresented Dr. Topol's opinion.
Watch this clip of an interview that directly discusses the Choosing Wisely campaign:
http://www.pbs.org/newshour/bb.....04-04.html
Mark| 4.13.12 @ 1:41PM
To clarify the above link: Dr. Topol is interviewed re: the Choosing Wisely campaign...and I do not believe his comments are represented by this article's author.
Frank Drackman| 4.13.12 @ 10:02AM
Only bit of Hippo-Crates thats relevant in todays adversarial Medico-Legal Environment.
"Fists, Do some Harm"
Frank
2Anglico| 4.13.12 @ 10:16AM
Yeah, and the SS told people they were only going to take a shower and not to forget where they left their stuff. The government DOES NOT CARE ABOUT ANYBODY.
The government has no business being involved in "healthcare".
Gary B| 4.13.12 @ 10:27AM
The government has no business being involved in "healthcare".
Or in anything else.
Gary B| 4.13.12 @ 10:26AM
As Katniss Everdeen observed: "It's easier destroying things than making them."
What a coincidence... that's the Democrat's platform.
KennesawJack| 4.13.12 @ 12:55PM
I wonder if Obamarx and his minions have any idea how many Everdeens there are out here in the hinterlands.
Louis Jenkins| 4.13.12 @ 10:27AM
The Hippocrates oath is outdated. Just like the Constitution, the three segments of government, and such. Just ask Obama. I believe there are times when the patient's joice may take presidence over the physican's trying to take care of the patient, however, to blatently state that grandmother, when suffering a heart attack, should just take a pain pill is absurb.
None of the elected overseers are enrolling in Obama care. None. And this is better for us minions who roll around in the mud? What is good for the goose is good for the gander. It sounds nice when Obama's speak machine is in high gear, but when we listen there's a world of injustice there. Hope you are ready, cause medicine will not be what it once was.
Claypoole| 4.15.12 @ 9:42AM
Engraved in marble outside the Supreme Court building are the words, "Equal justice under law." If the president and Congress--and other privileged people--are exempt from Obamacare, how can the Supreme Court see that as "equal justice"?
kwan| 4.13.12 @ 10:44AM
Collectivist Medicine or ObamaCare is all about quantity versus quality. The goal here is to provide health care for everyone not necessarily the best health care. Under ObamaCare the survival of the patient will no longer be the primary concern but creating the illusion of health care for all will be. Obama stooge and economic advisor Robert Reich makes it clear that under ObamaCare your survival will depend on how much it costs the government, and what if any value you are to the state. "We're going to have to, if you're very old, we're not going to give you all that technology and all those drugs for the last couple years of your life to keep you maybe going for a couple of months. It's to expensive...so we're going to let you die."....Robert B. Reich. Yes it would seem that the social engineers of the left are planning on using ObamaCare to cull the herd of useless eaters.
Nite| 4.13.12 @ 10:32PM
You have hit the nail on the head. Seniors are the population that will be culled first. They will start looking at other population groups that are expensive to treat and have no worth to the government. Chronic diseases, handicapped etc. We will have no say in whether our loved one lives or dies. Our Doctors will be told what care they can give. Families will be in a terrible position. The Congressional Democrats, and Obama all voted for this nightmare and they are exempt. Not a single Republican voted for it, so the Democrats clearly own it.
Frank Drackman| 4.13.12 @ 12:19PM
they say when you type in all caps its LIKE YOUR SHOUTING!!!
well, Ahem,
THE TUSKEEGEE EXPERIMENT, WHICH BTW, STARTED UNDER FDR AND WAS ONLY ENDED BY RICHARD N.NIXON, WAS GOVERNMENT HEALTHCARE!!!!!!!!!!!!!!!
and don't try and blame Alabama, last thang they wanted back then was a bunch of Luetic(look it up) lunkheads roaming the Country Side...
Frank
Jack London| 4.13.12 @ 12:41PM
Goldberg's article, as usual, is a pack of fearmongering lies. Choosing Wisely is based on evidence, and we do have a massive overtreatment/overtesting problem. It won't be solved any time soon by Star Trek like handheld devices that cheaply scan people for brain tumors. But someone should scan Goldberg for signs of intelligence.
And thanks to Mark above, for the Topol interview. Yes, he does say individual care is paramount - that's what any good MD should be doing anyway. But:
'In cardiology, all too often, every year, we have nuclear stress tests ordered as a routine, knee-jerk thing. And that exposes each individual to a lot of radiation, equivalent to thousands of chest X-rays.
'And this is just crazy that it's continuing. And it's about time that we saw professional societies like cardiology and these others start to make a statement that this is not the acceptable norm.'
LiveFreeOrDie| 4.13.12 @ 1:17PM
The federal government can, and will make better decisions about your health care than you and your doctor.
The federal government should make those choices.
This is your position? No thank you, I'd rather keep my freedom to choose.
Jack London| 4.13.12 @ 2:27PM
You're not paying attention – this article is about physician groups, not the government, promoting evidence-based medicine.
Mark| 4.13.12 @ 1:44PM
Right--Dr. Topol notes that decisions should be individualized, but within the context of avoiding unnecessary, useless, or even harmful testing.
More medicine does not necessarily equal better medicine...and when 1/3 of healthcare spending is likely unnecessary, then we need to address that while still ensuring patients receive necessary care.
DRed| 4.13.12 @ 4:35PM
I don't understand how conservatives complain constantly about entitlement spending, but also strongly oppose any efforts to limit spending.
Mike Hawk| 4.13.12 @ 9:36PM
Conservatives want to rein in spending. Liberal RINOs won't and don't have the spine to take on the free spending Liberal Democrats. They are too concerned about what they will say about them. So I take it you apporove of reckless free spending of money we don'y have and hasn't been earned yet. (Yes, I said earned.)
DRed| 4.14.12 @ 1:02PM
Do you not understand that eliminating unnecessary medical testing reduces the money spent on healthcare?
Mike Hawk| 4.14.12 @ 6:18PM
Who is to determine what the excess spending is, government buearucrats/ panels of drones or the doctor?? The doctor risks a lawsuit if thoses tests aren't done. A larger expense factor is the number of treatments done for illegals and others who do not pay the bill. We do. BTW, you clown, I worked in the Medical field for several years, my Ex was an RN and have friends who are MDs. I know well where the costs are. You only regurgitate what the liberal talking points are.
DRed| 4.14.12 @ 8:11PM
Well, this initiative is from the American Board of Internal Medicine. It's not a government organization (why the author of this article harps on the fact that a private organization is not run by people elected by the voting public escapes me). I presume the board understands the risks of malpractice lawsuits. You don't think it would be good to limit the amount of money we spend on medically unnecessary tests? Fine, but don't complain that we spend too much money on healthcare.
Sue| 4.14.12 @ 10:52PM
Sooooooo funny. It's "excessive, wasteful, spending" when others use it. What is it when you need it for yourself? Justified? Yeah. That's what I thought you would say.
FiddlerBob| 4.14.12 @ 12:31AM
This looks great for the lawyers.
If they represent the patient they can sue if too few tests are ordered, if the physician doesn't provide a completely flawless diagnoses prior to examination, or if they patient dies.
It they represent the government they can sue if any tests are ordered, if any non-approved exam is provided or diagnosis is given, or if the patient lives.
Mike Hawk| 4.14.12 @ 6:11PM
This is why there will be a doctor shortage in short order. They will quit practice and younger people will not go into practice or weven to Med school due to the high cost of being sued for anything that goes awry.
FiddlerBob| 4.14.12 @ 7:57PM
It won't just be the high cost if something goes awry. It's also that they won't have much or any choice over how and where they can practice, what field of medicine they will be allowed to enter, or whom they can treat.
Personal relationships with patients will be discouraged. In fact, applicants showing too much empathy may find it difficult to get accepted to government controlled medical schools. Our Obama Age doctors will be expected to assist in the termination of all unacceptable "expenses", young or old.
Those who stay in or enter the medical field will have the value of their expertise and work determined arbitrarily by a government panel. Their ability to prescribe appropriate treatments and remedies for their patients will be subject to government review not only of the medical appropriateness, but measured against the value the panel assigns to the life expectancy of the patient. Oh, and the panel won't be working on weekends. So please be courteous and plan your medical crisis during normal business hours.
The plum jobs and the greater percentage of research funds will be going to the sons, daughters, and friends of influential politicians. Can anyone say, "solar powered defibrillators"?
So, what's not to like?
Chris| 4.15.12 @ 4:58PM
I have heard that Obamacare also mandates more minority admissions to med school. If the standards have to be lowered, they'll just have to be lowered. Less qualified a.a. doctors will be good for medicine right?
Fewer doctors, worse doctors, more lawyers, what's not to like?
POST American| 4.22.12 @ 11:30PM
----Speaking of capstone EUGENICS
and as we are still waiting for your first
real piece of reporting and journalism on the
----GATES/Monsanto GM Food Halocaust----
--CATCH THIS--
"Understand, your babies blood has been
taken at birth for 4 decades now. It's put
into a secret government data base. You
say 'So what?' ----so this: should you fnd
yourself in critical condiction in a hospital
the doctors on the scene punch you in to
a computer to see if you're to be given the
treatment or not ----whether you're to be
save or not. And this is just the begining."
-Informed online
--------------YOU HAVE BEEN WARNED------------
Jared | 4.30.12 @ 7:10AM
Good piece. It is also important to remember that, at root, this style of medicine is being promoted in the service of a moral code that regards as ideal the notion of people sacrificing what is the best care for themselves in order to do something "for the group." Altruism is deadly.
Steven Vogel| 4.30.12 @ 12:55PM
? I'm confused. The "Choosing Wisely" site says that the recommendations are indeed evidence-based, and although Goldberg says this is false he doesn't explain this claim. And it also says that these are recommendations that "physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation." Isn't that what the quotation from Osler says too? There's nothing in Goldberg's post here that persuades me, or even gives me reason to believe, that the "Choosing Wisely" recommendations will be harmful to people's health.
InpatientMed| 5.1.12 @ 8:23AM
I am a physician and while I appreciate the need to order appropriate tests and being judicious about it, I am concerned that governing bodies of medicine make such recommendations. The ACP and the AMA are both proponents and backers of ACA and yet neither have addressed the reason why docs order so many tests. Liability in medicine is real and ruinous. Until real liability reform takes place, there will be no voluntary reduction in tests ordered.
These organizations had the opportunity to shape legislation and advocate for the medical profession. They chose instead to throw their lot behind an administration intent on telling people what to do and how to do it. They have suffered a loss of credibility in the profession that will be very difficult to get back.