Wednesday, September 25, 2013

Conservative Medicine: Who needs to read it?

"Don't just do something, stand there." This deliberate rephrasing of "don't just stand there, do something" reminds me that the typical impulse of a physician to take immediate action in the face of clinical uncertainty can sometimes lead to a worse outcome than exercising patience, collecting more information, and waiting for any harmful conditions (if present) to declare themselves in time.

However, as I explained in this week's MD Global Health podcast, powerful monetary and psychological incentives present throughout the health care industry push physicians, advocacy groups, and medical institutions to aggressively seek out and treat persons with "underdiagnosed" diseases, expand the definitions of existing diseases (e.g., pre-osteoporosis, or low bone density), and sometimes, create new diseases (e.g., restless legs syndrome) out of whole cloth. Recognizing that these issues are often exacerbated by expert consensus recommendations of dubious quality, a distinguished international working group recently proposed a short list of questions that, if properly implemented, could permit clinicians and patients to evaluate financial conflicts of interest in clinical guidelines.

Conservative Medicine will not only outline a list of problems that result from overtesting and overtreatment, but offer a set of solutions in the areas of medical education, public policy, regulation, and patient advocacy. Who needs to read it? I believe that my book will appeal to a broad audience of health professionals, journalists, policymakers, and ordinary people with and without defined health problems who wonder if they actually need "preventive health care," and if so, how much.


This is the sixth and final entry in a series of brainstorming posts about a book that I am writing titled Conservative Medicine.