Cochrane Sustainable Healthcare: evidence for action on too much medicine

Abstract

Medical excess threatens the health of individuals and the sustainability of health systems.[1][2][3] Unnecessary tests, treatments, and diagnoses bring direct harm to people through adverse e ects of interventions,[3][4] psychosocial impacts of labelling,[5] and overwhelming burden of treatment.[6] Overuse and overdiagnosis also consumes scarce resources, leading to underuse and underdiagnosis in other areas, which indirectly harms patients.[7] As healthcare spending grows all over the world,[8] with poor correlation between increased costs and improved health in high-income countries,[9] there is growing recognition that much of that spending is unnecessary.[1][2] Increased costs of healthcare also draws resources from other societal sectors capable of improving health and wellbeing for the population.[10] By tackling the crisis of medical excess, we can reduce harm and prevent waste, making our health systems more sustainable and more beneficial for patients and societies.

Disclosure of funding sources and conflicts of interest in evidence underpinning vitamin D and calcium recommendations in bone health guidelines

“…(25) Second, there is existing concern around a focus on supplementation in relation to overprescribing and over testing. (9,(29)(30)(31)(32) For instance, the International Osteoporosis Foundation partnered with DSM, a multi-corporation of health, nutrition and materials, and identified a global need for vitamin D supplementation based on claims of widespread deficiency. (9,33)…”

“…Thus, the pharmaceutical industry could be driving the bone health research agenda, and subsequent guideline recommendations, by producing an evidence base that is oriented towards supplementation (25) . Second, there is existing concern around a focus on supplementation in relation to overprescribing and over testing (9,(29)(30)(31)(32) . For instance, the International Osteoporosis Foundation partnered with DSM, a multi-corporation of health, nutrition and materials and identified a global need for vitamin D supplementation based on claims of widespread deficiency (9,33) .…”

The Case for Sustainable Endoscopy as a Professional Priority

“…A sustainable healthcare system maintains population health, reduces disease burden and minimises use of healthcare resources. Medical excess-or overuse of medical care with no benefit to the patient-threatens the health of individuals and poses challenges for healthcare sustainability (22). Serious problems associated with medical excess are already very evident and these include antibiotic resistance and the US opioid crisis(23).…”

A comprehensive model for measuring real‐life cost‐effectiveness in eyecare: automation in care and evaluation of system (aces‐rwm™)

“…However, the recently founded the Cochrane Sustainable Health care Group specifically focuses on a medical excess which threatens the health of individuals and the sustainability of health systems (Johansson et al. 2019, https://sustainablehealthcare.cochrane.org). The group pushes for (1) a broad consideration of resource use, (2) promoting a more sensible prioritization of financial and human resources, and (3) considering the treatment burden for individual patients.…”

“…Although acknowledged long ago, such side effects have been mostly ignored (Fisher & Welch 1999). However, the recently founded the Cochrane Sustainable Health care Group specifically focuses on a medical excess which threatens the health of individuals and the sustainability of health systems (Johansson et al 2019, https://susta inablehealthcare.cochrane.org).…”