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25-02-2013 | Article

Academy releases top five neurological tests and procedures to question


Neurology Today


medwireNews: As part of a crusade to tame burgeoning medical costs that are projected to occupy 25% of the USA's Gross Domestic Product by 2025, the American Academy of Neurology (AAN) - along with 16 other societies - recently released a list of five treatments and procedures that doctors and patients should question.

The Choose Wisely campaign, a collaboration between the American Board of Internal Medicine Foundation and Consumer Reports, seeks to motivate patients to understand evidence-based recommendations, foster communication between them and their doctor, and make decisions that are better suited to their medical situation.

One recommendation discouraged the use of electroencephalography (EEG) for diagnosing headaches, claiming it serves no real advantage over clinical evaluations, does not improve outcomes, and only increases costs. Another item advised the avoidance of opioid or butalbital to treat migraines when more effective, migraine-specific treatments are available.

"Choosing Wisely is a first step towards improving the value of healthcare dollars," explained lead author, Annette Langer-Gould, an AAN member from Kaiser Permanente, to medwireNews. "We're going after the low hanging fruit of healthcare wasteful spending by targeting those practices we know are not necessary according to strong evidence that they do not help. In some cases they may actually be more harmful than beneficial."

The AAN had to whittle 178 submissions down to five according to potential harms and benefits to a patient, as well as discomfort and costs. Langer-Gould explained that most of the five items stem from both doctors over-prescribing treatments and patients unjustifiably demanding them.

Carotid imaging was identified as an inappropriate way to identify the cause of fainting since the symptom does not have anything to do with an occlusive carotid artery.

Interferon-beta or glatiramer acetate were noted as misguided prescriptions to prevent the development of permanent disability in progressive forms of multiple sclerosis.

"There are certain circumstances under which giving these medications are more harmful than beneficial but appropriate under other circumstances," Langer-Gould said. "That's really how it is in medicine; it's a matter of in whom and when is it appropriate to do this."

The AAN acknowledge that the campaign is not without controversy as some have raised concern that it advocates rationing while others note that too much care is, indeed, being provided but the ease of waging malpractice lawsuits fuels aggressive practice.

By Peter Sergo, medwireNews Reporter