There's little doubt that the U.S. wastes a lot of money on unnecessary health care. But pinning down the worst offenders isn't easy, as a fresh analysis of the scientific literature finds.
Published research on overuse is in pretty short supply, so rooting out waste by looking at the existing studies can be a little like limiting your late-night search for lost car keys to the spots right under streetlights.
Still, you've got start somewhere. And a group of researchers combed the literature, zeroing in on 172 papers (out of more than 114,000 relevant ones published between 1978 and 2009) to see where the evidence for overuse was strongest.
What did they find?
Improper use of antibiotics to treat upper respiratory infections (think colds and other viral infections) got the most scrutiny: 59 studies.
After that came a bunch of cardiology tests and treatments:
- Coronary angiography (17 studies)
- Carotid endarterectomy, or cleaning out the neck arteries that feed the brain (13)
- Heart bypass surgery (10)
The analysis appears in the latest Archives of Internal Medicine.
Overall, the literature review revealed there's not a lot to go on. "There are very few interventions that have been studied," says Deborah Korenstein, an internist at Mount Sinai School of Medicine and co-author of the analysis.
One reason, she tells Shots, is that it's quite difficult to define what constitutes inappropriate use. The key factor for overuse is when the harms of the test or or treatment exceed the benefits. In many cases, the standards aren't clear.
There's some evidence that use of antibiotics for viral respiratory infections has declined, she says, and that's also true for some of the the overused heart procedures. All the more reason, she says, to get more serious about studying excess use of health care.
Screening tests are ripe for study. The number of people who get screened for various maladies, such as colon cancer, is so large that even a small amount of overuse can affect a lot of people, she says.
And there are examples that boggle the mind. Take, for instance, a 2004 estimate that 10 million women in the U.S. were getting Pap smears for cervical cancer despite having had their cervixes removed.
"The fact there's so much overuse when we looked at extreme cases suggest that it's likely there will also be overuse when we look at gray areas," Korenstein says.
Even when the data are present, it's can be difficult to change behavior. "I think people have a hard time understanding that overuse is harmful. If a procedure is good then more of it must be better," says Korenstein. "Attempts to stop overuse have come across as rationing and have not been received well.