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to have prostate surgery as irrational. He related that he (Dr. Welch) would never have to make those decisions “because I will never be tested.” Dr. Welch regularly visits media outlets preaching the gospel of sin- gle-payer and no testing. It worked! Consider this Choosing Wisely recom- mendation from the American Acad- emy of Family Practice: Do not rou- tinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam. Wow — with the stroke of a pen


TMA’s Be Wise — ImmunizeSM offers grants of up to $2,500 to fund vaccination events. Apply today.


We’re here to help. Visit www.texmed.org/


bewise, then “Funding Your Be Wise — Immunize Event”


Email TMA’s outreach coordinator at


tmaoutreachcoordinator@ texmed.org


Call (800) 880-1300, ext. 1470 Be Wise — Immunize is a joint


initiative led by TMA physicians


and the TMA Alliance, and funded by the TMA Foundation.


Be Wise — Immunize is a service mark of the Texas Medical Association.


we have eliminated most prostate cancer expenses; aren’t we smart? How did a few papers trump the col- lective experience of urologists? Oth- er executive boards polished that up a bit and suggest no screening on men with less than a 10-year life survival expectation. (As the average life ex- pectancy is 74+, you folks entering into Medicare better get your stuff done, pronto.) Perhaps I am more sensitive to this than most because I am 70 years old and sitting, literally, on a Gleeson 7, biopsy+ prostate. I wonder how long it will be before I am forced to “choose unwisely” based on the opinions of a panel inspired by Dr. Welch and this new quasimedical movement. Should I jump the gun for surgery now, knowing that my age may restrict me in the future more than my cancer? The issue of “testing harm” needs further examination before the cher- ished skills learned from decades of practice are arbitrarily rejected. If you make no money off a throat culture, and it is your instinct that you need one, why should you be subjected to insurance panel review based on compliance to negative, opinion- based political guidelines? That’s coming — you will be rated on how much unnecessary lab and images you order as dictated by these politi- cal committees. It’s ironic that the “no testing” movement is being champi- oned by diagnostic internists. Despite statements in the Decem- ber issue of Texas Medicine that the


14 TEXAS MEDICINE March 2015


lists for this program are “evidence- based” (a mantra that elicits good feelings from people in the know but has no extrinsic definition) — the truth is, with few exceptions the lists were put together with minimal con- sideration other than the opinions of a handful of executive committees representing each organization — they were political and not academic. I respect my executive committee greatly, but their opinions are not a substitute for practice parameters and guidelines. As time goes by, a mad rush will occur to save money for the system by doing less for the patient based on the latest cost-savings study done by an insurer or physician em- ployed by a health or academic sys- tem. The classic example in the latest issue of Texas Medicine was that the executive committee from the Ameri- can College of Cardiology had to re- verse its stand stating that unblock- ing only the culprit occluded coronary artery was enough and that unblock- ing all the arteries was costly and un- necessary. Those greedy cardiologists looking at all the other blocked arter- ies were proven correct.


No one truly knows the number of “unnecessary tests” for anything except by extrapolation of a relatively small set of vague data generated by health systems and insurers to reduce their expenses. “If we don’t restrict tests, the insurers will” is the common rebuttal. I am not so sure. Choosing Wisely is a platform for


insurance coverage, measurement, and payment based on reverse guide- lines — period. Let us pray that these new, dumbed-down, negative guide- lines don’t restrict the fleeting liber- ties we have always enjoyed in our patient advocacy. Let us hope TMA isn’t hoodwinked


in incremental programs leading to single-payer rationing. n


BOB LANIER, MD, is the executive medi-


cal director of the American College of Allergy Asthma and Immunology and past president of the TMA Foundation and the Tarrant County Medical Society.


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