New back pain guidelines, psych drug overuse in the elderly, and more

February 16, 2017

In order to bring you more of the news you want to read, Right Care Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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Good news for right care! The American College of Physicians has updated its guidelines on treatment for low back pain, recommending physical therapy and other alternative treatments instead of medication. This is a welcome change from its previous guidelines, which recommended medication as the first choice for treatment. “Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs for these patients,” said Nitin S. Damle, MD, president of the ACP, quoted in USA Today.

Nearly half the number of retirement-age Americans who were taking at least three psychiatric drugs had no mental health diagnosis on record, according to a study reported in The New York Times. Data used came from government surveys of office-based physicians and found the number of patients affected doubled between 2004 and 2013. “The biggest jump was in rural areas,” said Mark Olfson, MD, one of the authors, “which suggests…that the increases partly reflect doctors and patients falling back on medications when they have little access to other options.”

When Providence Health acquired Swedish Health in 2011, the profits from Swedish-Cherry Hill Hospital’s neuroscience program increased dramatically—but at great human cost. A Seattle Times investigation of the program finds that financial incentives for doctors to increase their patient volume have led to unnecessarily invasive procedures, more medical errors, and higher rates of simultaneous surgeries. An accompanying piece features the heartbreaking story of how a young patient was affected by the hospital’s “high-volume approach.”

This week, a public health argument against Trump’s immigration ban came from the pediatrician who blew the whistle on the Flint, MI lead poisoning crisis. In The New York Times, Mona Hanna-Atisha, MD, an Iraqi-American pediatrician, previously featured on the Lown Institute blog, writes of her experience as an immigrant for whom “the American Dream was [her] reality.” She points out that losing thousands of potential doctors from the seven banned countries could be a public health disaster for rural areas that often depend on foreign-trained doctors for medical care.

A report issued last week by the Government Accountability Office found that hospitals and physicians failed to report cancer spread from the use of power morcellators, a tissue-cutting device used in removing benign uterine tumors, as published on Weak oversight by the FDA allowed the device to stay in use for years. In 2013, the device came into focus after physicians Hooman Noorchashm, MD and his wife Amy Reed, MD, (who developed leiomyosarcoma from the device), launched a campaign to ban its use. See their petition here.


Challenges to Professionalism in a Time of Change, a joint program of the Lown Institute, Maine Medical Association, New Hampshire Medical Society, Vermont Medical Society, Maine Alliance of Health Care Professionals, and others, will take place Saturday, June 17, 8 am to 4 pm at the Sheraton Portsmouth (NH). Keynotes are Thomas Bodenheimer, MD, MPH, professor, family community medicine at UCSF School of Medicine and Eric Campbell, PhD, professor of medicine at Harvard Medical School. Information here.

Deadline extended: Early bird registration for the 5th Annual Lown Institute Conference has been extended until February 28. Don’t miss your opportunity to take advantage of our discounts for the best medical conference of the year, May 5-7 in Boston. Register now. And don’t forget to nominate your colleagues and teammates for a Right Care Alliance Award.

Another deadline to remember: Submissions for the Right Care Vignette Competition are also due February 28. We are seeking clinical vignettes written by trainees describing harm or near-harm from medical overuse. Submit your vignette here.

Lown Institute Senior Vice President Shannon Brownlee will be a guest speaker next week at UC Berkeley School of Public Health Dean’s Speaker Series. Her address, Beyond Coverage: After the ACA, will focus on our nation’s fragmented, market-based health care system. This event, co-sponsored by the UC Berkeley Graduate School of Journalism and part of the 2016-2017 Kaiser Permanente Lecture Series, takes place Thursday, 5-7 pm at University Hall, UC Berkeley. Watch this event live here.




Clinician health

Cost of care

Disparities and inequalities

Doctor-patient communication

Drug costs


Lancet Right Care series

Mental health

Population health

Public health


Social determinants

Women’s health


RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.


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