Inside Medicine: Overtreatment remains common

Published: Wednesday, Aug. 21, 2013 - 9:08 pm

If everyone does something, that doesn’t make it right. Or in the case of medical care if everyone orders something that doesn’t mean it’s needed.

There are many common treatments and tests we know simply do not work. Classic examples of discredited treatments include vitamins like vitamin C to prevent colds, many other natural treatments, and over-the-counter medications such as cough medicine.

Study after study show they don’t work, but we allow them to be sold and dispensed under the banner of consumers’ freedom of choice. We could, if we wanted, put a sign on the store shelves above these medicines that informs the public that “studies show this medicine doesn’t work — waste your money if you wish.”

The concept of signs above medicines is not new; at my local drugstore there are all sorts of other signs announcing sales, two for one offers and the like. The reason such education campaigns won’t happen is that everyone except the consumer wins in the conspiracy to sell a product we know doesn’t work — the manufacturer, doctors, distributors, and the store itself. Even parents win, as they can pretend they are giving little Johnny something to stop that awful cough.

Let me not stop with cough medicines. A highly regarded report that reviewed dozens of well-done studies has, yet again, concluded that using high-blood-pressure medicines to treat otherwise healthy people with mild hypertension (blood pressure of 140 to 159 over 90 to 99) does not reduce death, strokes or heart attacks. Chances are you haven’t read about this prestigious study and chances are your doctor won’t change his approach to treating mild hypertension because of it. In fact, recently American experts went in the opposite direction and actually changed the definition of hypertension by lowering the upper number (systolic pressure) from 160 down to 140. Overnight this change resulted in 13 million new adults considered hypertensive. And, not accidentally it added 13 million customers to those for whom treatment is recommended.

Every single person who needs treatments that are proven to reduce death or disease should certainly get those treatments. But do we really need to treat people who don’t need it? We know only too well that overdiagnosis and overtreatment cause waste and harm — psychological harm and physical harm.

Why all this push to treat people who will not benefit? Because pharmaceutical companies have a huge influence over medical treatments as they have for decades around high blood pressure. The major groups of medical experts making treatment recommendations are not simply smart people as we would hope — they are paid consultants to drug companies. For example, nine out of 10 members of NIH’s Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure, the group upon whose guidance we are asked to follow, had conflicts of interest, such as that they were paid consultants for makers of blood pressure medicines. Can these people really be honest brokers? Why were they not immediately disqualified from the panel? These same conflicts are present on other U.S. and international groups of experts dealing with all sorts of medical and mental health conditions.

The affordability care act offers us the chance to revisit treatment goals and expert opinions. Unbiased groups of genuine experts such as the U.S. Preventive Services Task Force offer us a chance to apply best evidence to the practice of medicine and in so doing reduce unnecessary treatments and overuse. But the powers that want to maintain the status quo or drive toward overuse are so powerful that the only thing that can balance their drive for overtreatment is an equally powerful force focused on the rational use of medical science.


Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at drwilkes@sacbee.com.

Read more articles by Dr. Michael Wilkes



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