Author Archive

How not to debate a “pro-vaxer”

When people debating against vaccines win, children lose.

When people debating against vaccines win, children lose.

To say that the relationship that antivaccine activists have with science and fact is a tenuous, twisted one is a major understatement. Despite mountains of science that says otherwise, antivaccinationists still cling to the three core tenets of their faith, namely that (1) vaccines are ineffective (or at least nowhere near as effective as health officials claim; (2) vaccines are dangerous, causing autism, autoimmune disease, neurodevelopmental disorders, diabetes, sudden infant death syndrome, and a syndrome that is misdiagnosed as shaken baby syndrome; and, of course, (3) the Truth (capital-T, of course!) is being covered up by a nefarious combination of big pharma, the medical profession, and the government (in the US, primarily the Centers for Disease Control and Prevention, which works with pediatricians to produce the recommended schedule of vaccines). Because vaccine rejectors don’t have science on their side, they have to resort strategies common to science denialists like those who reject the scientific consensus about evolution or human-caused global climate change. These fallacious strategies include (but are not limited to) selective citation of evidence (i.e., cherry picking), misrepresentation and logical fallacies, impossible expectations about what science can deliver (e.g., vaccine denialists expecting 100% efficacy and 100% safety from vaccines or cancer quacks expecting 100% cure rates and no side effects from chemotherapy); fake experts (e.g., Andrew Wakefield); and, of course, conspiracy theories. Add to that appeals to personal freedom and “health choiceüber alles and painting any form of vaccine mandate as incipient totalitarianism, with those rejecting vaccines taking on the role of the Jews in Hitler’s Germany, and you have a pretty good idea of the sorts of arguments antivaccine activists resort to.

Not surprisingly, even the most diehard antivaccine advocate can get frustrated. After all, it must be very frustrating to have one’s posterior handed to one in arguments on the science of vaccines time and time again. Of course, for that purpose, like most science denialists, antivaccine activists have the Internet. In particular, they’ve taken full advantage of Facebook, and, more recently, Twitter. One such online gathering place is the public group known as Vaccine Resistance Movement (VRM). I encourage pro-science advocates to peruse this group, just to see that when I refer to people being anti-vaccine, there is no doubt that that is what they are. It was there that I found a rather telling document posted, for the benefit of antivaccine advocates everywhere.

Posted in: Critical Thinking, Vaccines

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Stanislaw Burzynski and Robert O. Young: How two quacks of a feather illustrate how poorly states regulate medical practice

Stanislaw Burzynski (upper panel) and Robert O. Young (lower panel), two quacks whose activities reveal the weaknesses in how the practice of medicine is regulated.

Stanislaw Burzynski (upper panel) and Robert O. Young (lower panel), two quacks whose activities reveal the weaknesses in how the practice of medicine is regulated.

One of the weaknesses in our system of regulating the practice of medicine in the United States is that, unlike most countries, we don’t have one system. We have 50 systems. That’s because the functions of licensing physicians and regulating the practice of medicine are not federal functions, but state functions. Each state sets its own laws and regulations governing the practice of medicine, making for wide variability from state to state. Some states are lax in their regulation (cough, cough, I’m talking to you, Texas), others are not so lax.

Given how often state medical boards and the other enforcement bodies states use to protect the public from professional misconduct and quackery, I thought I’d take this opportunity to update our readers on two men who have been frequent topics of discussion on this blog, Stanislaw Burzynski and Robert O. Young. The reason is that, through some bizarre confluence of events, both of them faced justice last week, in the form of a hearing due to action against Burzynski by the Texas Medical Board, and in the form of the trial of Robert O. Young in southern California.

What these two quacks share in common is that they’ve gotten away with their cancer quackery for a very long time, two decades in the case of Robert O. Young and nearly four decades in the case of Stanislaw Burzynski, with attempts by the law to bring them to heel having been largely ineffective. They are different in that one is a physician (Dr. Burzynski) and one is not (Young) and therefore different legal considerations come into play. Young, for instance, is a self-proclaimed naturopath known for his “pH Miracle Living” cure, which, he claims, can be used to cure basically any disease by “alkalinizing” the body. After two decades of running, he is being tried for practicing medicine without a license, and, of course, fraud. Burzynski, although not an oncologist, is a licensed physician in Texas and has been administering an unproven and almost certainly ineffective “natural” treatment consisting of substances derived from blood and urine that he dubbed “antineoplastons” (ANPs) back in the 1970s. He is also different in that he’s gotten away with this largely through abuse of the clinical trial process, which is regulated at the federal level through the FDA and the HHS. It is not, however, the federal government that is pursuing action against Burzynski, but rather the Texas Medical Board (TMB). Thus, while Young is on trial and could go to jail if he loses, if Burzynski loses he will only lose his license to practice medicine in the state of Texas.

Despite their differences, both Stanislaw Burzynski and Robert O. Young illuminate major shortcomings in how the legal system deals with quacks.

Posted in: Health Fraud, Politics and Regulation

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On “integrative medicine” and walking and chewing gum at the same time

Walk and chew gum at the same time

I didn’t think I’d be discussing Dr. David Katz again so soon. In fact, when Mark Crislip (who clearly hates me, given how often he sends me links to articles like this) sent me a link to Dr. Katz’s latest article, “Cleaning the House of Medicine“, published—where else?—in The Huffington Post, that home for “reputable” quack-friendly bloviation since 2005, when I first read the article, my first reaction was that Katz must surely be trolling us here at SBM. At first, I wasn’t going to respond to him again. However, Katz’s article represents a very common misconception about science-based medicine that is worth refuting. It is not my intention to be arguing back and forth with Dr. Katz every couple of weeks, but I did think it worth one more round. I think you’ll understand why by the end of this post.

First, however, a brief recap is in order for readers who might not have been following the discussion over the last month or so. It all started a couple of weeks ago, when Jann Bellamy, in response to a special issue of the American Journal of Preventative Medicine edited by Katz and dedicated to making the case for integrative medicine in preventive medicine training, quite correctly discussed how “integrative medicine” is always all about the “potential.” Indeed, after having spent considerable sums of federal grant money studying the “integration” of pseudoscience into medicine with respect to preventive care, the journal couldn’t come up with any concrete examples how integrative medicine adds anything (other than quackery) to medicine. Dr. Katz, who is well-known in the world of quackademic medicine for his infamous 2008 speech in which he asserted that physicians need to use a “more fluid concept of evidence” in evaluating treatments, particularly “complementary and alternative medicine” (CAM), responded with another HuffPo article entitled “Science and Medicine, Fools and Fanatics: The ‘Fluidity’ of Woo“. In lieu of reasonable, science-based arguments, Dr. Katz’ article was little more than a rant that consisted mainly of outrage that mere mortals lacking his awesome academic credentials had had the temerity to question his awesomeness and dedication to science coupled with an accusation that we are just too rigid and simplistic in our thinking to understand the subtle complexities of how different standards of evidence must be applied to complex patients. Steve Novella and I both responded that we understand just fine, explained how doctors do this all the time without using quackery like naturopathy and homeopathy (both of which Katz has advocated), and pointed out his argumentum ad ignorantiam with respect to energy medicine.

There’s where I thought it would end. Unfortunately, I was mistaken. On Friday, Katz launched another broadside at us, couched in the form of an argument that medicine must “clean its own house” before worrying about his quackademic medicine. It’s something I hear often enough that I thought it would be worth responding to, even if Dr. Katz was indeed trolling us.

Posted in: Critical Thinking, Medical Academia, Quality Improvement, Surgical Procedures

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To debate or not to debate: The strange bedfellows of Andrew Weil

Andrew Weil

To debate or not to debate, that is the question.
Whether it is nobler in the mind to suffer
The slings and arrows of outrageous quackery
Or to take arms against a sea of quackademia,
And, by opposing end them.

Hamlet, Act III, Scene 1, paraphrased badly.


The question of whether it is worthwhile to debate cranks, quacks, and advocates of pseudoscience has long been a contentious issue in the skeptic community. Those of you who’ve been reading my posts for a while know that I’ve always come down on the side that it is not a good idea One thing I’ve learned in my more than a decade of blogging, both here and at my not-so-super-secret other blog, is that advocates of pseudoscience love public debates. Indeed, whenever you see a skeptic agree to a public debate with an advocate of pseudoscience, it’s a damned sure bet that it wasn’t the skeptic who proposed it. I suppose it’s possible that there have been such instances that I’m unaware of, but I do know of a lot of instances where it was the other way around. I’ve even witnessed one myself, when our fearless founder Steve Novella debated antivaccine quack Julian Whitaker about vaccine safety at FreedomFest in Las Vegas while we were at TAM three years ago. Steve mopped the floor with Dr. Whitaker so dramatically that it almost changed my mind about the value of debates with quacks because, witnessing the debate, I saw that the arguments Dr. Whitaker marshaled were such hackneyed antivaccine talking points that I knew I could also have demolished them. Still, in the end, no minds were likely to be changed, and the question of vaccine safety was clearly being used as a tool to oppose school vaccine mandates or, as antivaccinationists like to call them deceptively, “forced vaccination.” Whether vaccines are safe and effective or not is a separate question from whether the government should mandate certain vaccines as a precondition for attending school or being in day care.

Over the years, I myself have been “challenged” to similar debates myself. Perhaps the most bizarre example occurred when someone claiming to represent HIV/AIDS denialist Christine Maggiore contacted me claiming that she wanted to arrange a debate between us. Maggiore, unfortunately, died a mere two years later of—you guessed it—AIDS-related complications. Although occasionally the ego gratification of being asked to participate in such events vied with my longstanding belief that debating cranks doesn’t sway anyone, sharing the stage with a real scientist does unduly elevate the crank in the eyes of the public. Besides, whatever the seeming outcome of the debate, you can count on the crank to declare victory and his believers to agree. In any event, science isn’t decided by the metrics used to judge who “wins” a public debate, which rely more on rhetoric and cleverness rather than science to decide the outcome. Finally, such debates are not without risks. Although Julian Whitaker, for example, was terrible at it, other cranks are adept at the Gish Gallop, and an unprepared skeptic or scientist can be made to appear clueless in front of a crowd that is almost always packed with supporters of the crank, not the skeptic.

Just last week, there was another “debate” challenge that led me to question my resolve not to debate cranks. It came from a most unexpected source.

Posted in: Medical Academia, Medical Ethics, Science and the Media

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The suffering the search for “natural immunity” inflicts on children

Yes, there are people out there who believe that there are "natural" remedies for pertussis and willing to let their children suffer the consequences.

Yes, as hard as it is to believe, there are actually people out there who believe that there are “natural” remedies for pertussis and willing to let their children suffer the consequences.

I realize that Scott Gavura has already covered this particular case (and quite well), but it’s so egregious that I couldn’t resist discussing it myself because it is one of the most horrifying examples I’ve seen in a long time of the consequences of the sorts of beliefs that fall under the rubric of naturopathy. Quite frankly, reading the story angered me to the point that I didn’t feel it would be unduly repetitious to discuss it again. The result in this case was the prolonged and unnecessary suffering of three children, while the mother believed she was helping them.

Naturopathy is a cornucopia packed to the brim with virtually every quackery known to humankind, be it homeopathy, much of traditional Chinese medicine, vitamin C for cancer, or basically any other pseudoscientific or prescientific treatment for disease that you can imagine. I feel obligated to start most of my posts about naturopathy with a statement like this not just because it’s true but because I want to remind my readers that it’s true. I particularly want to remind my readers when I see naturopaths revealing their true quack selves when they think no one’s watching, but I want to remind them even more when I see a post like the one by a naturopath named Heather Dexter entitled Natural Remedies for Whooping Cough: Getting Through It IS Possible. The post has been disappearing and reappearing with new edits for the last few days, but it seems to have disappeared for good. Fortunately the Internet never forgets, and in addition to the versions captured by Scott, the original text can still be found on Reddit, although it takes some scrolling to find it, and, for now, a Google cache version still exists.

If you want anecdotal evidence of the depths of quackery to which naturopaths can descend, read this post now. Because the link to the original post was removed once, I saved the text and will quote it liberally, but, for whatever reason, the post appears to be up again at Like-Minded Mamas, which promises “easy, natural answers for every mama’s journey.” What Dexter sees as natural treatment of her children with whooping cough, I see as child abuse. Worse, Dexter is practicing in my own state in Grand Rapids, MI.
Dexter describes herself thusly:

Heather Dexter is a Board Certified Naturopathic Doctor, Certified Affiliated Bradley Method Instructor, Certified Holistic Doula, Certified Usui Reiki Master Practitioner.

Here’s an indication: If you believe in reiki enough to practice reiki, you are a quack.

More importantly, if you treat your children the way Dexter describes, you are a child-abusing quack, in my not-so-humble opinion. Why do I say this? Because in her post Dexter describes how she tortured her children by letting them “get through” pertussis. Let me repeat that again in a different way. She let her children suffer through the natural course of a pertussis infection in order to acquire “natural” immunity. She even brags about it near the end of her post:

Posted in: Naturopathy, Vaccines

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Authority versus science on integrative medicine

Should we respect David Katz's authority?

Should we respect David Katz’s authority?

David Katz doesn’t much like us here at Science-Based Medicine. In fairness, I can’t say that I much blame him. We have been very critical of his writings and talks over the years, dating back as far as Steve Novella’s deconstruction of one of Dr. Katz’s more infamous statements about using a “more fluid concept of evidence” to Kimball Atwood’s characterization of his tortured logic to my pointing out that his arguments frequently boil down to a false dichotomy of either abandoning science or abandoning patients.

Last week, Jann Bellamy did her usual great job discussing an unfortunate special supplement of the American Journal of Preventative Medicine (AJPM) entitled Integrative Medicine in Preventive Medicine Education. This supplement included articles summarizing the results of project called IMPriME (Integrative Medicine in Preventive Medicine Education), funded by the Health Resources and Services Administration (HRSA), to advance the inclusion of “integrative medicine” in Preventive Medicine residency programs. Not surprisingly, this project was led by Dr. Katz. Jann used this special issue as a jumping off point to show, quite correctly, how, when it comes to so-called “integrative medicine,” it is always about the “potential,” which has always been elusive and has never been realized. Unfortunately, the elusiveness of the amazing potential attributed to “integrative medicine” (formerly referred to as “complementary and alternative medicine” or “CAM”) has done almost nothing to dampen the ardor of its cheerleaders for “integrating” as much woo as they can into medicine, which is why a major journal would allow someone like David Katz to edit a special issue dedicated to articles discussing IMPriME’s findings.

Thanks to Jann’s post, it appears that Dr. Katz is most displeased with us again here at SBM. To express his displeasure, he has rattled off a little rant over at his usual non-academic hangout and quack-friendly Internet outlet, The Huffington Post. There, he castigates us with a post entitled Science and Medicine, Fools and Fanatics: The ‘Fluidity’ of Woo. Yes, right off the bat, it’s the same old strategy, to paint advocates of “integrative medicine” as the “reasonable” ones while those of us who object to integrating prescientific quackery into medicine are clearly the “fanatics” (or, if you prefer, the fools). In it, as usual, Dr. Katz lays down some real howlers in defense of his integration of woo with medicine.

Posted in: Basic Science, Critical Thinking, Medical Academia

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Matt Ridley’s not-so-mythical “myth” of basic science

Matt Ridley: Specious arguments against government research funding.

Matt Ridley: Specious arguments against government research funding.

I’m a clinician, but I’m actually also a translational scientist. It’s not uncommon for those of us in medicine involved in some combination of basic and clinical research to argue about exactly what that means. The idea is translational science is supposed to be the process of “translating” basic science discoveries in the laboratory into medicine, be it in the form of drugs, treatments, surgical procedures, laboratory tests, diagnostic tests, or anything else that physicians use to diagnose and treat human disease. Trying to straddle the two worlds, to turn discoveries in basic science into usable medicine, is more difficult than it sounds. Many are the examples of promising discoveries that appeared as though they should have led to useful medical treatments or tests, but, for whatever reason, didn’t work when attempted in humans.

Of course, if there’s one thing that the NIH and other funding agencies have been emphasizing, it’s been “translational research,” or, as I like to call it, translation über alles. Here’s the problem. If you don’t have basic science discoveries to translate, then translational science becomes problematic, virtually impossible even. Translational research depends upon a pipeline of basic science discoveries to form the basis for translational scientists to use as the starting point for developing new treatments and tests. Indeed, like many others who appreciate this, I’ve been concerned that in recent years, particularly with tight budgets, the NIH has been overemphasizing translational research at the expense of basic research.

Posted in: History, Politics and Regulation, Science and Medicine

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Antivaccinationists and the Nation of Islam protest in front of the CDC, but don’t you dare call them “antivaccine”

Flyer for "CDC Truth" Rally. Apparently a bunch of antivaccine activists showed up in Atlanta on Saturday to annoy CDC employees and try to use the manufactured "scandal" of the so-called "CDC whistleblower" to attack vaccines. Same as it ever was.

Flyer for “CDC Truth” Rally. Apparently a bunch of antivaccine activists showed up in Atlanta on Saturday to annoy CDC employees and try to use the manufactured “scandal” of the so-called “CDC whistleblower” to attack vaccines. Same as it ever was.

If there’s one thing that’s guaranteed to anger most antivaccine activists, it’s a skeptic calling them “antivaccine.” The reason, of course, is that (1) many of them actually believe they are “not antivaccine” but rather “pro-vaccine safety,” even though their words and actions proclaim otherwise and (2) they crave legitimacy. They want desperately to be taken seriously by the government and scientific community. The problem is that, again, by their very words and actions they make it almost impossible for anyone who knows anything about vaccines to take them seriously, except as a threat to public health. They have no one but themselves to blame, as a critical perusal of Age of Autism, The Thinking Moms’ Revolution, VacTruth (and VaxTruth), or any number of antivaccine websites and blogs will indicated to anyone of a scientific bent who has the intestinal fortitude to plunge down any or all of those rabbit holes of magical thinking and pseudoscience.

Another thing that I’ve come to understand over the more than a decade that I’ve been doing this is that there is a profound tension between what I like to call the two wings of the antivaccine movement. Basically, as is the case in most political or ideological movements, antivaccine activists gravitate towards one of two views. The first (and most prominent view) tends to be the pragmatic view. These are the antivaccinationists who deny vociferously that they are “antivaccine” and instead portray themselves as “pro-safe vaccine.” They want to appear reasonable and are willing to take partial victories on an incremental path towards achieving their ends. Then there are the “loud and proud” antivaccine activists. They don’t eschew or hide from the term “antivaccine.” They embrace it and proudly proclaim that they believe that vaccines are irredeemably toxic, that they don’t protect against disease, that big pharma is a criminal syndicate intent on poisoning their children and turning them autistic, and that the CDC is complicit in the whole plot. Of course, like all ideological movements, there is not a dichotomy; rather, there is a continuous spectrum between the two. Also, in this case, the two groups differ more on tactics than actual beliefs. As I’ve found many times, push a “reasonable” antivaccinationist, one who proclaims herself “not antivaccine” but “pro-vaccine safety,” and it’s usually not hard to get them to say things indistinguishable from the hard core antivaccinationists. They’ll basically cling to their self-perception as “pro-safe vaccine, while making the same evidence-free claims that vaccines cause autism, sudden infant death syndrome (SIDS), autoimmune diseases, diabetes, and all the other conditions on which antivaccinationists blame vaccines.

Posted in: Politics and Regulation, Public Health, Religion, Vaccines

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The American Cancer Society’s new mammography guidelines: Déjà vu all over again

The American Cancer Society’s new mammography guidelines: <em>Déjà vu</em> all over again

One of the things that feels the weirdest about having done the same job, having been in the same specialty, for a longer and longer time is that you frequently feel, as the late, great Yogi Berra would have put it, déjà vu all over again. This is particularly true in science and medicine, where the same issues come up again and again and again, often with the same arguments on either side. Sometimes the same players are even involved. So it is with mammography recommendations. Indeed, I’m feeling déjà vu all over again right now, as I read headlines like “Women advised to get mammograms later, less often“, “American Cancer Society, in a Shift, Recommends Fewer Mammograms“, and “ACS: Breast cancer screening should begin at age 45“. What provoked these headlines was a major revision in the American Cancer Society’s recommendation for mammographic screening for breast cancer in women at average risk of the disease. In a seeming replay from 2009, when the United States Preventative Services Taskforce (USPSTF) sent shockwaves through the breast cancer world by recommending that most women not start mammography until age 50 and then only to have it done every two years instead of every year, the American Cancer Society (ACS) has now just similarly ratcheted back its recommendations for screening mammography, just not as much as the USPSTF did. The new recommendations were communicated in a special communication published by JAMA on Tuesday.

What changed regarding mammography recommendations

Before we get to the issues, how, specifically, did the ACS change its mammography recommendations? Before this change, the ACS basically recommended the same thing that most other American professional societies dealing with breast cancer did: yearly mammography starting at age 40 for the rest of a woman’s life. The new guidelines now recommend that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years and continuing annually until age 54. From age 55 and older, the ACS recommends that women transition to every two years. (More details below.) As I Tweeted when I saw these recommendations, basically it appears that the ACS has more or less split the difference between the old recommendations and the USPSTF recommendations.

So why is the ACS changing its recommendations? And what does this say about the science and our values regarding cancer screening? If you’ve been reading this blog, you know that over the last several years there has been a steady drip, drip, drip of studies that range from highlighting the downside of widespread mammographic screening to downright questioning the value of mammography. That’s why I’ve been discussing rethinking screening for breast cancer since at least 2008. Basically, you can go back and read my old posts and, if you have a lot of time and are enough of a glutton for punishment to read them all, watch the evolution of my thinking about breast cancer screening over the last seven years.

Back in the day, I used to fully support breast cancer screening beginning at age 40 and proceeding yearly throughout. As I examined more and more of the evidence, I became less enthusiastic about screening so intensely and started to believe that starting at 40 was too young for most women. Indeed, I was probably the only breast cancer doctor at my cancer center in 2009 who supported the USPSTF recommendations when they were announced, which led to some—shall we say?—interesting discussions about what should be said to the press and what a press release our cancer center wanted to release ASAP should actually say. I also got myself into a little…trouble…for criticizing colleagues in radiology—not from my institution, I hasten to add!—for some rather blatant turf protection. Let’s just say that a prominent radiologist, one who’s achieved far more renown in his field than I ever have in mine, was most displeased with some of my commentary and let me know about it. I found this displeasure odd, given that I am most definitely not a nihilist with respect to mammography screening (and, make no mistake, there are quite a few of those out there these days). I’m just a lot more balanced and aware of its limitations than I used to be. On the other hand, I did call him out for some of his more obnoxious comments that implied that those who question mammography are cackling gleefully at the thought of more women dying of breast cancer. Interestingly, I don’t seem to get asked to contribute to such press releases that much anymore, but in fairness neither do most of the other breast cancer clinicians I work with; so I probably can’t blame it on my previous outspokenness.

What brought me to this point is an increasing understanding of the concepts of overdiagnosis and lead time bias, coupled with a string of studies that show more modest benefits (and, in one case, no benefit) from screening mammography. To be honest, the attack dog reaction by some mammography supporters to some of these negative studies also set my skeptical antennae a’twitchin’ as well.

Posted in: Cancer, Public Health

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Choosing Wisely: Changing medical practice is hard

OK, so Choosing Wisely isn't quite like this, but it's still very important.

OK, so Choosing Wisely isn’t quite like this, but it’s still very important.

We here at Science-Based Medicine like to point out that arguably the most striking difference between science-based medicine (and the evidence-based medicine from which we distinguish it) and alternative medicine, “complementary and alternative medicine” (CAM), or (as it’s called now) “integrative medicine” is a concerted effort to change for the better. In other words, in SBM, we are continually doing studies to improve practice. These studies take on two general forms: Comparing new treatments with old to determine if the new treatments work better and, as has become an imperative over the last several years supported by more research dollars, comparing existing treatments in order to determine which ones work better. In the case of the former, we are trying to add to our knowledge and thereby add more effective treatments, while in the case of the latter we are trying to weed out treatments that are less effective and/or less safe or that cost more money to produce the same results. Indeed, the rise of an explicit framework, evidence-based medicine, is a result of the desire of medicine as a profession to improve what it is doing. (Yes, I know this blog frequently criticizes EBM, but in the case of treatments that have science behind them EBM and SBM should be—and usually are—synonymous.) This is in marked contrast to CAM, where treatments based on prescientific vitalism never, ever go away, no matter how many clinical trials show them to be no better than placebo and basic science shows them to be ludicrously disconnected from reality.

An example of this imperative to make things better is Choosing Wisely. This is an initiative launched in 2012 in which the American Board of Internal Medicine (ABIM) Foundation challenged specialty societies to produce lists of tests and interventions that doctors in their specialty routinely use but that are not supported by evidence. The explicit goal of Choosing Wisely was to identify and promote care that is (1) supported by evidence; (2) not duplicative of other tests or procedures already received; (3) free from harm; and (4) truly necessary. In response to this challenge, medical specialty societies asked their members to “choose wisely” by identifying tests or procedures commonly used in their field whose necessity should be questioned and discussed. The resulting lists of “Things Providers and Patients Should Question” was designed to spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments.

Posted in: Clinical Trials, Politics and Regulation, Quality Improvement

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