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Americans are overdiagnosed, overtreated – and overdosed.



With all the vendors, providers, and manufacturers urging us to get more medical care (always somehow “showing savings” in the process), isn’t it nice to know there is one vendor dedicated to putting guardrails around employees’ tendencies to overuse medical care?


After all, you are subsidizing most of their purchases, and Economics 101 says that the less someone pays for something, the more of it they buy. And buying healthcare is good for us, right? Isn’t that why they call it healthcare? [SPOILER ALERT: Answer is below.*]


We’ve written posts and of course quizzes on all the ways in which people overuse the medical system. As one example, we educate employees/members not to demand unneeded and expensive (meaning highly profitable) scans. Not just because of the radiation (in CT scans) but also because of the strong potential for overdiagnosis, meaning “findings” that are unrelated to the reason for the scan, and are ultimately harmless but nonetheless are disconcerting and might cause a patient or a doctor to want to follow up. These findings are so common they even have a name: “Incidentalomas.”


Overdiagnosis of incidentalomas leads inexorably to overtreatment…especially for back pain. We blog and quiz on this topic extensively as well. Longtime Quizzi-fans no doubt recall our mantra: “80% of back pain goes away on its own, but 80% of people with back pain are convinced they are in the other 20%.” Americans lacking access to Quizzify (which is, sadly, still the majority) treat back pain far more aggressively than they should.


Just last week, an article appeared in Becker's Spine Review validating our concerns by agreeing that way too many spinal fusions are performed. https://bit.ly/4c1ja1I.  And this overtreatment is only going to get worse as these surgeries move outpatient, making them way easier to agree to ("You'll be in and out in a day") even when they shouldn't be done at all.


We are far from alone in identifying this “epidemic of overuse” as Atul Gawande calls it. Books have been written on each. We recommend Overdiagnosed by Gilbert Welch and Overtreated by Shannon Brownlee.

Too many drugs


Another topic we address is overuse of drugs. Once again, we are far from the first to note this. Our colleague Alan Cassels described it almost 20 years ago in Selling Sickness: How the World's Biggest Pharmaceutical Companies are Turning us All into Patients.


In particular, Quizzify focuses on the hazards of popular over-the-counter remedies that are safe when used as directed for a limited period...but not when used for an unlimited period. Heartburn meds, antihistamines/decongestants, sleep aids, laxatives and pain relievers – the five most popular categories of OTC drugs – are all overused by segments of the population, and all have underappreciated hazards of overuse. But many people assume that the ready availability of those drugs means they are safe. Often the hazards of long-term overuse don’t get noted on the label, which lists only the known side effects of drugs when used as directed. A great example – one that is very pertinent these days because of weight-loss drugs – is laxatives. Some are decidedly unsafe.


Prescription drugs are overused as well. 20% of Americans over 40 take 5 prescription drugs every day. Quizzify has specific (antibiotics, painkillers) and general quizzes on prescription drugs, which should lead people to their own conclusion that they get enough drugs without demanding more of what they see on TV.

The latest on drug overuse and misuse


That statistic and this blog post (along with their cover picture at the top) was inspired by an excellent article in last week’s Economist, “Too Many People Taking Too Many Pills.” Many of the key concerns in this article are addressed in Quizzify. The concerns include:

  1. “Advertising oversells the benefits of medicine.” You think? They didn’t include any statistics, but a Journal of the American Medical Association study showed that the large majority of advertised drugs did not provide better therapeutic value than less expensive non-advertised alternatives.

  2. People tend to be “unaware of the consequences of long-term use.” This is especially true of over-the-counter (OTC) drugs, which people assume are safe because, well, there are no restrictions on sale. Particularly in conjunction with weight-loss drugs, laxatives have become top sellers. Yet some are decidedly unsafe.

  3. Doctors can also be unaware of hazards of drugs. Partly because there are a ton of drugs to keep track of. And partly because even though they are usually aware of the side effects and drug interactions on the FDA Insert, the label itself often falls short, as it is initially based on trials only. Later, in a voluntary, cumbersome, time-consuming and hit-or-miss process, the label may be updated, if enough doctors report “adverse events.”

Quizzify to the rescue


Quizzify isn’t going to solve all these problems, but you’d be surprised how much of a dent you can make in all three of them for $12 PEPY or less.


First, our quizzes on taking pills very specifically address the stats on advertised drugs, and educate on the reasons a doctor might acquiesce in a patient’s demand for a not-so-great drug instead of proposing a better alternative or none at all. And why you shouldn't always ask for whatever you just saw advertised. Yet people do, which is why most drug companies spend more on marketing than R&D.


A lot has to do with patient satisfaction. The so-called “Triple Aim” of cost, quality and satisfaction assumes those three can be harmonized. But pushing back on inappropriate demands for drugs (and scans etc.) sacrifices the last to achieve the other two. There is also a time element. It takes quite a bit less time to write a prescription (or order a test) than to explain why such a prescription (or test) is a bad idea.


To the second point, if there is one thing that Quizzify excels at, it’s raising user awareness of the “consequences of long-term use” of OTC drugs. Millions of Americans rely nightly on those harmless-looking sleep aids (you know, the ones with the moons and stars and zzzzz’s on them), without understanding the many hazards of long-term use. Not just in our quizzes on pills, but we squeeze this info into whatever quizzes we can. Like, did you know that if you are over 50 and are already experiencing a noticeable prostate issue (a reduced “stream”), these pills can worsen those symptoms?


Likewise, our quizzes cover the hazards of long-term use of heartburn pills and pain relievers. In all cases, we simply provide the factoids in a trivia game format and let users come to their own conclusions.


One of th fastest-growing segments of OTC drugs combines both pain relief and sleep aids, in some cases with a little alcohol thrown in besides. Just not a good idea to take nightly. And yet, without Quizzify, who is advising your employees on this?

That brings us to the third point. Who better to report adverse events in real time than the patients who suffer them? And there is a website where patients can do exactly that, www.drugs.com. This site, the Rotten Tomatoes of the pharmaceutical industry, captures and publishes ratings and user reviews for drugs, tagged to the conditions (including off-label use) for which they are prescribed.


It's front-and-center in Quizzify2Go. Quizzify2Go's 201 Doctor Visit PrepKits include 150 which anticipate possible prescriptions that might be recommended. Or, thanks to the aforementioned drug advertising, that might be demanded. Those PrepKits link directly to that drug’s ratings and reviews. Linking directly is key because for all its value, the site itself needs our guidance for two reasons:

  1. The ratings and reviews are buried;

  2. For some reason the generic and the brand name are not linked. They are reviewed and rated separately even though they are the same chemical and 99% of users should get the same result.


At a minimum, patients can know what to expect from the drug they are prescribed. Or whether there might be a better-fit drug. Or whether people have reported side effects or interactions that would have otherwise gone unnoticed.


The massive number of drugs and supplements on the market, and the many combinations in which they can be taken, means formal tracking of interactions misses many. Not to mention doctors can't keep track of them all.


Perhaps one-third of the time, we find that the most widely prescribed drug for a particular condition has somewhat lower ratings and worse reviews than other drugs for that condition. Consider prostate enlargement as an example. Flomax (tamsulosin) is prescribed far more often than Cialis (tadalafil), but the latter is rated much higher by users.


Of course, it is not our role to tell people what drugs to take, but rather only to provide the information which they may choose to use or not.


*As we teach employees, the answer is not always yes: "Just because it's healthcare doesn't mean it's good for you."




 
 
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