Shannon Brownlee: All Related Content

Flu season is still here, and Hoffman-LaRoche, the manufacturer of the anti-viral drug Tamiflu (oseltamivir) are still running an ad intended to market directly to patients. "Sometimes what we suffer from is bigger than we think. The flu is a big deal, so don't treat it like a little cold. Treat it with Tamiflu." If you didn't get the message from these ads, the U.S. Centers for Disease Control and Prevention has also issued public service announcements urging people to get Tamiflu at the first sign of a sniffle or sneeze.

“We have a disease care system,” not a health care system, says Shannon Brownlee, senior research fellow at the New America Foundation and author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer. “And the disease care system…

“All too often, what the patient might prefer doesn't even come up, and it's the clinician's opinion and personal beliefs that determine the course of treatment,” said Shannon Brownlee, lead author of the report and an instructor at the Dartmouth ...

Health writer Shannon Brownlee of the New America Foundation says the issue is a prime example of what she calls American medicine's tendency to overdiagnose and overtreat disease. She's the author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.

Original article

No fiscal policy event is complete without the plaintive cry that health care costs are out of control. The phrase has become a form of rhetorical boilerplate that is often used to imply that policy makers are helpless in the face of market forces, and that the only way to reduce "costs" is either cutting benefits or rationing.

This op-ed is co-authored by Jeff Borkan, Chair of the Department of Family Medicine at Brown University School of Medicine.

The media attention and Congressional investigation into the tragic epidemic of spinal meningitis in people who had injections for back pain has focused on unsanitary conditions at the compounding pharmacy that produced the medications. At last count 620 cases and 39 deaths have been confirmed in 19 states because the steroids used in the injections were contaminated with a common fungus. Yet remarkably little has been said about the underlying cause of this tragic outbreak -- the widespread overuse of an unproven procedure (epidural steroid injections) that put the contaminated steroids into the spinal cords of patients in the first place.

The procedure involves inserting a needle into the spinal canal, one of the most vulnerable parts of the human body, and then injecting steroids, which are supposed to reduce inflammation and allow the back to heal. Each year, more than 9 million Americans are treated with spinal steroid injections, and one study found that the number of Medicare recipients undergoing this procedure increased by 159 percent between 2000 and 2010.

How did steroid injections come to be performed so often? Patients assume that most medical treatments are supported by years of careful studies. They think any invasive procedure that might put them at risk of harm is performed only by trained and certified physicians with rigorous clinical oversight.

In the case of spinal steroid injections, nothing could be further from the truth. There is no widely accepted guideline for the use of epidural steroids, and the U.S. Food and Drug Administration has never specifically approved steroids for that use. There is scant medical evidence to show that the use of epidural steroids is any more effective at relieving back pain than routine, conservative care or even sham (fake) injections. There are many possible side effects of this procedure, and while the most serious complications are rare, they can be disabling or life threatening. Yet this unproven, risky treatment is routinely offered on an outpatient basis by physicians who have widely varying levels of training and expertise. While most of those physicians undoubtedly believe they are acting in their patient’s best interest, there is no escaping the fact that they are paid nicely for a procedure that takes only a few minutes to perform.

There's no doubt that regulators should go after the makers of unsafe medications. Slipshod manufacturing practices can't be tolerated when people's lives are at stake. At the same time, we need to rethink our willingness to pay for procedures and tests that have known risks and unknown benefits. Epidural steroid injections are just one of myriad examples of such treatments, and taken together, the overuse and misuse of medical procedures is costing us dearly, both in terms of wasted dollars and wasted lives. It’s time to build a health care system that serves patients rather than profits, and the first step is recognizing tragedies like the spinal meningitis outbreak for what they are, cases of overuse.

“It often is the physician's preference that wins the day,” said Shannon Brownlee, a Dartmouth instructor who led the national study. The researchers compared how often Medicare recipients from various areas of the country underwent a dozen types of ...

Shannon Brownlee, a co-author of the study, said the prevalence of specialized facilities, such as heart-catheterization labs, also appears to push up rates. "Fact is, if you have a lot of supply there, it tends to get used and it affects, in a ...

"Many patients aren't even aware that the choice about elective surgery is theirs to make," said lead author Shannon Brownlee. "The result is that patients don't really get the treatment they prefer." The report by the group, which is affiliated with ...

Shannon Brownlee, the study's lead author and an instructor at the Dartmouth Institute for Health Policy & Clinical Practice, attributes the differences to physicians who impose their preferences on uninformed patients. “Many patients are not even ...

That might not reflect what the patient truly wants or needs, study lead author Shannon Brownlee said. “Patients often don't get the treatment that is best for them,” she said, “and that's one of the main things that drive this unwarranted variation ...