When It Comes to Some Medical Treatment, Researchers Find Less Is More

Beyond its effects on the body, medical care can be a balm for the mind. Extensive treatment can feel like a promise that doctors have done everything possible. But that perceived security can come at a high price. As health costs soar, patients are emptying their pockets for care that may not make them healthier, research suggests. Last year, a 5,000-person trial showed that for patients with chronic but stable heart disease, surgical procedures such as stenting and bypass did not reduce the risk of heart attack or death more than lifestyle interventions and medication. Even patients with extensive damage did not, on average, experience fewer heart problems after surgery than those who simply took meds, ate well, exercised and didn’t smoke.

The findings upended assumptions about cardiac care, says co-author Dr. Robert Harrington, a cardiologist and the chair of the department of medicine at Stanford University. Harrington says doctors have long assumed surgery is the way to go for patients with blocked arteries–but the new study adds nuance to that notion. “We can’t just trust our intuition. We need data,” Harrington says. “I actually think this is a good thing for medicine, to pause and think, Why do we do that?”

Across the medical field, doctors are reconsidering the status quo. Many surgeries are medically necessary and even lifesaving–but increasingly, evidence suggests invasive care shouldn’t always be a physician’s knee-jerk reaction.

A 2016 paper found that men who actively monitored their early-stage prostate cancer were no more likely to die over the next decade than those who opted for surgery or radiation. Research has shown that physical therapy can be just as restorative as surgery for a torn meniscus. Studies have found that C-sections are not only unnecessary for many deliveries but also potentially risky. Numerous minimally invasive alternatives to open surgery have been shown to be safer and equally effective. Taken together, these results from disparate corners of the medical field point to a changing approach to treatment.

That shift stands not only to improve patient outcomes; it could also chip away at care costs. A 2010 Institute of Medicine report estimated that overtreatment costs the U.S. medical system $210 billion per year. In a 2017 survey, U.S. doctors said more than 20% of medical care was unnecessary–even as access to care is lacking for many. Fear of malpractice lawsuits and patient requests or pressure were the most common reasons for ordering unnecessary prescriptions, tests and procedures, while more than 70% of respondents said physicians are more likely to perform unnecessary services when they profit from them.

Overtreatment also often begets overtreatment. In a fall 2019 survey of about 400 internists, 94% said they had observed an unnecessary “cascade of care”–an ultimately frivolous chain of interventions often triggered by a fluke test or screening.

Lead author Dr. Ishani Ganguli, an assistant professor of medicine at Harvard Medical School, says these cascades waste patients’ time and money and lead to unnecessary pain and stress. She and other doctors are bringing awareness to these consequences through research and resources like ChoosingWisely.org, a website that aims to spark conversation between doctors and patients about which tests and procedures are actually worth it. “Things are changing, but slowly,” Ganguli says.

Harrington, meanwhile, hopes the growing body of evidence on overtreatment will be seen not as a total condemnation of invasive procedures but rather as a call for more thoughtful treatment decisions. In some cases, of course, surgery will still be the right decision. But patients who opt against it can take comfort in knowing their health may not be the worse for it.