Choosing Wisely
The commonest cause of death and disability in our society is cardiovascular disease. The second commonest is cancer. Tragically, the third commonest cause of death and disability in modern society is Western health care. It is estimated that around 10% of admissions to hospital are due to medical error. Over 100,000 deaths per year in the United States are due to the appropriate prescription of pharmaceutical preparations.
NPS MEDICINEWISE in Australia has continued its Choosing Wisely campaign with further important recommendations which will hopefully improve these statistics and also reduce the enormous burden from medical costs in this country, but also carried by all countries around the world for exactly the same reasons.
This latest campaign has focused on 3 main areas:
1. The overall ordering of x-rays in children. There are far too many x-rays performed for children with respiratory complaints as the vast majority of respiratory tract infections can be managed clinically without a chest x-ray and certainly without antibiotics. This is also true for the vast majority of children with abdominal pain, where abdominal x-rays and, in particular, abdominal CT scanning carries little value in the diagnostic pathway. What all of this excessive radiation does, however, is predispose children to developing some form of cancer later on in life because of this excessive and unnecessary radiation.
2. Encouragement of people to remain in the work force for as long as possible. This recommendation tries to encourage doctors, patients and employers to focus on capacity and not incapacity. To quote the president of the Australasian Faculty of Occupational and Environmental Medicine, Associate Professor Peter Connaughton, “we are recommending doctors only certify patients being totally unfit for work when it is clinically necessary. Where appropriate, we are encouraging willing patients to continue working in some capacity as part of their overall healthcare management. Declaring a person medically unfit for work can often see them experiencing a range of issues including loss of self-esteem, feelings of isolation, depression and anxiety, as well as poor physical health and slow recovery times from their injuries.”
Safe Work Australia estimates that work related injury and time away for illness can cost the Australian economy around $61.8 billion per year in direct and indirect costs such as loss of productivity. There is no doubt that a return to the work force is good for the individual and good for the country. Not only are the fiscal benefits obvious, but the sense of purpose and the ability to socialise outside of their immediate family and friends has profound physical and psychologic benefits.
3. Over the past decade there has been a significant backlash from the public regarding the widespread prescription of medications for a variety of conditions. One of the great cases in point here is that of statin therapy. It is estimated that around 19 million prescriptions are written every year in Australia alone and with 12 prescriptions per year per patient, this implies that just under 2 million people in the Australian population are prescribed statins. There is no doubt that this is excessive and unnecessary and with prolonged use, many chronic side effects can arise such as muscle issues, poor thinking and even increased risk for diabetes.
This new recommendation focuses on the fact that many people over the age of 65 are taking 5 or more different pharmaceutical preparations for a variety of conditions. Unfortunately, sometimes this is necessary but the problem is that many people in the modern world have been influenced to think that there is a pharmaceutical solution to every problem. This recommendation suggests that the risk of medication related harm rises significantly once the amount of regularly prescribed medications exceeds 5 and exponentially when greater than 8. The list includes benzodiazepines such as Valium, a variety of antipsychotic agents, hypoglycaemic agents to treat diabetes, antithrombotic agents to thin the blood, antihypertensives, antianginals, statins and the proton pump inhibitors.
When you visit your doctor and an investigation or treatment/procedure is suggested, ask the following five questions:
1) Why do I need this?
2) What are the risks?
3) Are there safer, simpler or more natural options?
4) What happens if I don’t have this?
5) What are the costs involved?
The reality is that practising the 5 keys to being healthy
1) Quit all addictions
2) Develop a good quality sleep habit (7–8 hours per night)
3) Eat less, and eat more naturally
4) Exercise 3–5 hours per week
5) Cultivate peace and happiness every day
reduces your risk for all diseases somewhere between 70–80%. Taking a medication on average has around a 20–30% reduction in most common diseases but with the potential for significant side effects. Once you’ve been prescribed multiple medications then the drug interactions abound.
I congratulate the Choosing Wisely Australia campaign for bravely examining the current practice of medicine in this country which can only help to improve the general health of the population. Although strong medicine has strong effects, it also has strong side effects and complications and all doctors must be reminded of the first line of the Hippocratic Oath, first do no harm.
