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Editorial | April 12, 2010

Less Is More

Arch Intern Med. 2010;170(7):584. doi:10.1001/archinternmed.2010.48.

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Our current health care system operates on the unspoken but widely prevalent belief that more care is always better than less and that new technology is always better than older methods. Yet, there are many cases in which these assumptions are wrong. Clearly, these erroneous assumptions negatively affect health by exposing patients to unnecessary harms of treatment and testing, with no expected benefit; they also increase the total cost of health care.

To stimulate a conversation on this topic, the editors of the Archives are excited to launch a new feature: “Less Is More.” This feature will identify articles that document cases in which less health care results in better health and offer commentary on the specific implications. Some examples of this phenomenon from recent issues of the Archives include evidence that (1) the risk of developing cancer in association with unnecessary computed tomographic scans is substantial¹^- 3; (2) there is a wide variation in the use of feeding tubes in nursing homes, with no demonstrable benefit of their use⁴; (3) there is unexplained variation in use of antipsychotic agents in nursing homes, many for patients without any indications for use⁵; and (4) there is evidence that elderly persons do the same or better with careful drug discontinuation.⁶ We also invite our readers to submit vignettes from actual patient encounters or clinical experiences that illustrate how less is more.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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CME

Accreditation Information

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit^TM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 Credit^TM.

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For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes

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Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).

Compression-Only CPR: Pushing the Science Forward
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AAM 2010;304:1493-1495.

All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.

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