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THINK TWICE BEFORE CHOOSING WISELY


BY BOB LANIER, MD The Choosing Wisely campaign is a media stunt gone mainstream to prepare for sin- gle-payer rationing. Sorry, but I think it’s a major political mistake with unintended consequences, and the rah-rah support of the Texas Medical Association makes me nervous. I first became aware of Choosing


Wisely when, as executive medical director for a 5,000-member national specialty society, I was contacted for endorsement by the American Board of Internal Medicine (ABIM). The original task requested of our execu- tive committee was to identify the five most “abused or overused tests” ordered by physicians in our specialty either through ignorance or for per- sonal profit. I, of course, began to look for how this information was to be used and what the implications of the program might be. I found the Choosing Wisely concept was the brainchild of the National Physicians Alliance (NPA), http://npalliance.org, whose activities in the past few years included Support for Taxes on Soda and Sugary Drinks (August 2013);


Support of Comprehensive Health Workforce Reform to Improve Access, Quality, and Cost-Effectiveness of Healthcare (July 2013); Gun Violence — A Public Health Issue (February 2013); and Health Savings Accounts Harm Patients’ Health (September 2007).


The political agenda of NPA is


pretty straightforward, as this group was formed to advocate a national single-payer plan for medicine. Un- able to get traction with the concept initially, NPA teamed with Consumer Reports and spun the concept into an exposé on the “Five Tests patients should refuse when your doctor sug- gests them.”


That exposé got traction and at-


tracted political parties interested in reducing laboratory tests and x-rays because the major political theory circulating is, if unnecessary testing were eliminated, there would be no need for rationing with the advent of single-payer passage. The Robert Wood Johnson Foundation (RWJF) took up the cause and put their money behind it. With huge grant


monies from RWJF, the ABIM Foun- dation began contacting the specialty and state societies to redistribute these monies as grants. ABIM was pleasantly surprised at how easy the concept was sold to the leadership of state and specialty societies, espe- cially when dangling grant monies in front of them. TMA bought into the program as one of five states that got the grants.


The concept of Choosing Wisely slowly morphed from a tabloid me- dia-based project of reducing “five abused or overused tests” into a pro- gram against diagnostic testing — pe- riod. You may not understand that, so let me repeat — there are folks who believe that diagnostic testing as a concept is profit-driven, unnecessary, and greedy. They want to severely limit your diagnostic abilities. The guru of the movement is Dr. Gilbert Welch from the Dartmouth Institute for Health Policy and Clini- cal Practice. His book Overdiag- nosed: Making People Sick in Pursuit of Health, with foreword by Ralph Nader, is truly the bible of the Choos- ing Wisely movement, and interested doctors should review it to see what is really coming next for a program that sounds so apple pie and reason- able. In one particularly entertaining passage, he relates the personal de- cision by a clinical oncologist friend


I think it’s a major political mistake with unintended consequences.


March 2015 TEXAS MEDICINE 13


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