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April 12, 2010

Less Is More

Author Affiliations

Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

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

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 substantial13; (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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