The most influential articles on overuse from 2017

By Judith Garber | December 4, 2018

Each year, JAMA Internal Medicine publishes an update on overuse, featuring the top ten most influential articles on overuse from the previous year. Below are some highlights from this year’s update, from researchers Dr. Daniel J. Morgan, Dr. Deborah Korenstein, Dr. Sanket S. Dhruva, Dr. Eric R. Coon, and Dr. Scott M. Wright.

Unsurprisingly, the ORBITA trial made it into the top ten studies on overuse. This landmark trial found that stenting for stable angina does not offer more angina pain relief than a “sham” procedure, upending decades of conventional wisdom about the condition. This trial also made it clear that sham procedures are crucial for controlling for the placebo effect and should be more widely used before new procedures become standard practice.
Electrocardiograms (ECGs) are used to measure heart rhythm, to ensure that a patient’s heart is beating normally. However, ECGs are often overused, which can lead to “a cascade of additional downstream services,” researchers find. Out of 2.8 million low-risk patients studied for five years, 22% had an ECG with no indication for the test. Other overused tests include high-sensitivity troponin tests to detect heart attack and frequent cholesterol monitoring for statin-treated patients.
Patients who question overdiagnosis are often not taken seriously. In a study of patients had a small, incidentally identified thyroid cancer and questioned their clinician’s treatment recommendation, many “reported being told they were ‘stupid,’ ‘wrong,’ or ‘crazy’ for not pursuing the recommended care and experienced significant anxiety about this decision.”
Several studies published in 2017 addressed the overuse of medications. One study found that taking vitamin D and calcium did not reduce the risk of bone fractures in older adults. Another found that off-label use of painkiller pregabalin to treat sciatica is ineffective and often cause adverse events like dizziness. Lastly, antipsychotics for palliative care patients may actually worsen delirium, not lessen it.

The team identified 910 articles published in 2017 that addressed medical overuse. Interestingly, there were fewer articles published on overuse in 2017 compared to 2016 (when there were 1,224 articles on overuse). Is the medical research community’s interest in overuse waning? Maybe next year’s review will show whether this publishing dip is a one-off or beginning of a downward trend.

To read all of the top ten articles and summaries, check out the Update in JAMA Internal Medicine.

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

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