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Too much medicine is harmful

Knowing when not to prescribe, how to prescribe wisely and when to “deprescribe” are a challenge for healthcare professionals in which patients should be involved.

Through the ages, medicine has helped increase human life expectancy, as have access to safe drinking water and improvements in sanitation, housing conditions, diet and levels of education. But nowadays, at least in the wealthiest countries, more healthcare does not always mean better health.

A survey carried out in France in 2012 reveals that, overall, doctors consider that only 72% of medical treatments are justified. They feel that the main reason for unjustified treatments is patient demand. But according to another survey carried out the same year among a representative sample of the general population (1006 respondents), 75% stated that when they consulted a doctor it was mainly to receive advice or a medical opinion, and 28% often thought afterwards that the consultation had been unnecessary.

In 2013, the British Medical Journal launched the “Too much medicine; too little care” campaign to draw attention to the threat to health posed by overdiagnosis and overtreatment, and to the waste of public resources: “The movement to combat medical excess in wealthier nations embodies a much older desire to avoid doing harm when we try to help or heal.”

Similar initiatives have been launched, including that of the Journal of the American Medical Association (JAMA) which regularly publishes articles in its “Less is more” series.

Too many unnecessary interventions and too many harmful interventions: it is becoming increasingly clear that, faced with the vast array of diagnostic techniques and therapies available today, healthcare professionals need to know when not to use them, how to use them well, and when to “deprescribe”. It’s a worthwhile challenge and one in which patients should be involved.

©Prescrire 1 November 2013

"Too much medicine" Prescrire Int 2013; 22 (143): 278. (Pdf, free).

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