The director of the centre, Professor Adam Elshaug, said: ‘There is more awareness of the issue – this is a good start. As a result, we see declines in most areas.”
dr Rachel David, chief executive of Private Healthcare Australia, said choosing wisely is an “essential part” of Australia’s healthcare system.
“They have 39 recommendations targeting things that aren’t even surgery. That is the big problem.”
dr Joshua Zadro, University of Sydney
“I’m disappointed. It definitely filled a specific role. The education was aimed at both healthcare professionals and patients. It helped address the information asymmetry. Something should take its place.”
The spokesman for the Royal Australian College of GPs, Professor Mark Morgan, said that without Choosing Wisely “the march towards low-quality care might have been quicker”. The Australasian College for Emergency Medicine called the government’s decision “disappointing”.
A spokeswoman for Health Secretary Mark Butler said the decision to end funding for NPS MedicineWise – as part of reforms recommended by an independent review – would result in a greater role for Australia’s Health Safety and Quality Commission.
Educational programs to improve drug use are now “procured through open, competitive application processes,” the spokeswoman said.
The decision to cut funding for the service comes as Choosing Wisely faces questions about its effectiveness.
Despite a similar US campaign running for a decade, America still spends tens of billions on treatments that don’t work – leading to criticism that it has simply allowed doctors to look like they’re doing something without to do anything at all.
The Center for Health Policy study only looked at tests and treatments that Choosing Wisely recommended as low-quality — and those very recommendations could be flawed.
That’s because, rather than dealing with bad medicine in their own practice, doctors are more likely to target procedures from other specialists, a 2019 study found.
For example, out of 48 recommendations from surgical societies, only nine are aimed at surgery.
“They have 39 recommendations targeting things that aren’t even surgery. That’s the big problem,” said Dr. Joshua Zadro, University of Sydney researcher who led this study.
For example, the Royal Australasian College of Surgeons advises against using antibiotics to treat an inflamed ear canal. The Faculty of Pain Medicine advises against spinal fusion – a complicated operation – for lower back pain.
Other recommendations seem to have fallen on deaf ears, such as the Pharmaceutical Society’s requirement not to offer homeopathic products or to recommend unproven complementary medicine.
Zadro’s study also found that the vast majority of referrals weren’t aimed at revenue-generating practices—and when they were, they were practices that raised money for other specialties.
NPS spokeswoman Lindner argued it was unfair to expect that the “publication of a set of recommendations” would directly change the practice.
“An attempt was made to initiate a culture change by starting a conversation about what care is appropriate.”
But if that’s the case, “it was a very expensive icebreaker exercise,” said Professor Chris Maher, director of the Institute of Musculoskeletal Health.
“At best, it was a mediocre success.”
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