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When Doctors Are Paid Less, Unnecessary Prescriptions Drop

Take medical uncertainty. Add financial incentive to treat. Voila! Increased utilization. Now take away financial incentive to treat. Guess what you get?

MedPageToday explains, in the case of hormone therapy for prostate cancer:

Medicare accomplished what clinical guidelines and evidence-based medicine couldn’t: it reduced unnecessary use of androgen deprivation therapy (ADT) in prostate cancer.

Inappropriate use decreased by almost 30% from 2003 to 2005, following enactment of the Medicare Modernization Act, which lowered physician reimbursement for ADT. Appropriate use of ADT did not change during the same time period, according to an article in the Nov. 4 issue of the New England Journal of Medicine.

“Our findings suggest that reductions in reimbursement may influence the delivery of care in a potentially beneficial way, with even the modest [reimbursement] changes in 2004 associated with a substantial decrease in the use of inappropriate therapy,” Vahakn B. Shahinian, MD, of the University of Michigan in Ann Arbor, and co-authors wrote in conclusion.

“The corollary is that reimbursement policies should be carefully considered to avoid providing incentives for care for which no clear benefit has been established. The extreme profitability of the use of gonadotropin-releasing hormone (GnRH) agonists during the 1990s probably contributed to the rapid growth in the use of ADT for indications that were not evidence-based.”

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

The Simple Truth About Cholesterol

The New York Times recently ran a piece that wondered if doctors were treating patients with cholesterol-lowering medication unnecessarily because a web-based calculator over estimated a person’s risk. The program was proudly sponsored by the pharmaceutical roundtable and was available at the American Heart Association.

The implication was obvious. Simple tool determines an individual’s risk for heart attack or death from heart attack. It over estimates risk. Patients treated unnecessarily. To be also clear, the program did underestimate risk as well.

Unfortunately, the article missed an important point. While the simplified calculator may not be as accurate as the more complex algorithm used by the National Cholesterol Education Program, the truth is doctors are likely to be overtreating patients not because the former program is presented by the pharmaceutical roundtable, but for another reason. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Overmedicating Our Kids

One of the blogs I read by Maggie Mahar pointed out a new study that found that 26 percent of kids under age 19 are now taking prescription drugs for a chronic condition. The drugs include asthma medication, anti-psychotics, diabetes drugs, anti-hypertensives, and heartburn medications.

According to the Medco study (the largest pharmacy benefit manager), the incidence of type-2 diabetes increased over 150 percent in children between 2001 and 2009. This is staggering. Children are supposed to be healthy and active, not tied to a regimen of pills. Read more »

*This blog post was originally published at EverythingHealth*

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Latest Book Reviews

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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