Nobel laureate: Hospitals must reduce overtreatment

Hospitals must eliminate overtreatment to reduce waste and improve patient outcomes, renowned cardiologist Bernard Lown said in an interview with U.S. News & World Report.

An overabundance of caution in treatment has historically yielded negative results for patients, Lown, a Nobel laureate and founder of the Lown Cardiovascular Research Institute, told U.S. News. For example, he cited the once-common practice of confining heart attack patients to their beds for four to six weeks. "Bed rest was a form of medieval torture," Lown said.  "Strict bed rest promoted depression, bedsores, intractable constipation, phlebitis, lethal pulmonary embolism and much else." In addition, Lown said, there was never any empirical evidence the practice was effective in the first place.

Since it fell out of favor, he said, "I am not aware of a single cardiovascular measure since then that improved survival of [heart disease] patients as much as this common-sense change in medical management."

Similarly wasteful, overly cautious treatments continue with modern technology, however, according to Lown. For example, he recalled a case in which he was asked to consult about giving a burn victim a pacemaker, which was both unnecessary and would have done nothing to prolong her life. "If that were an isolated episode, it would be tragic," he said. "But that kind of thing happened daily."

Lown said he is encouraged by shifting attitudes on healthcare, and increasing acknowledgment of the hazards of overtreatment. "I would say categorically that things are shifting in public attitude," he told U.S. News. "[P]olitical change is made by people who are persuaded, convinced and ready to go to bat for an issue. They're worried but not intimidated by their anxiety. They are willing to act."

Very few physicians consciously set out to overtreat patients, Lown said. Rather, he said, there exists a culture in which "everything is tilted in the direction of doing more." But the timing is such that we think we can remind doctors, remind the tribe, of the calling of our profession," he said. "Financial security was always expected, but not the reason for getting into medicine."

Overtreatment is a major driver of waste in the healthcare industry, and clinical performance measures, reimbursement systems and the threat of malpractice liability will likely exacerbate the problem, FierceHealthcare previously reported.

To learn more:
- read the interview