Too Much of a Good Thing

The WSJ did a nice piece called “In Treatment, There Can Be Too Much of A Good Thing”.  Here are some highlights:

• Aggressive treatment of chronic diseases such as high blood pressure and diabetes has helped to reduce patient deaths. But a new study suggests some patients may be getting too much treatment, increasing their health risks.The study, published Monday in the Journal of the American College of Cardiology, reviewed electronic health records of nearly 400,000 patients at Kaiser Permanente Southern California who were taking medication for high blood pressure, or hypertension. The report suggests patients whose blood pressure is reduced below optimum levels are at an increased risk for death or kidney failure.
• In the case of diabetes, in which the body can’t control the amount of sugar in the blood, a study by Yale School of Medicine researchers of Medicare data found a growing problem of people with diabetes being hospitalized because their blood-sugar level had dropped too low, possibly because of overly aggressive treatment. In the enthusiasm to control blood sugar, patients are put at risk, the researchers say.
• Dr. Sim says hypertension patients should be evaluated based on individual risks. Consider, for example, a 70-year-old man on blood-pressure medication who has osteoporosis. If he experiences dizziness and is at risk of falling, his doctors may want to consider adjusting his medication and monitoring his blood pressure carefully, Dr. Sim says.
• Earlier this year, the American Geriatrics Society, as part of a campaign known as Choosing Wisely, recommended that for patients 65 and older, doctors should avoid using medications to achieve HbA1c levels below 7.5%. “Tight control has consistently been shown to produce higher rates of hypoglycemia in older adults,” the group said. Reasonable targets would be 8% to 9% in older adults with multiple medical conditions and shorter life expectancy, it said.
• Kasia Lipska, an endocrinologist at Yale and lead author of the hypoglycemia hospitalization study, says in both hypertension and diabetes, “there are a lot of pressures for physicians to reach these special targets, but there isn’t a bottom number.” And in both diseases, she says, “lower is not always better.”
• In the study of Medicare beneficiaries ages 65 and older, Dr. Lipska and colleagues found that hospital-admission rates for high blood sugar, or hyperglycemia, had sharply declined between the years 1999 and 2011. Those rates are now surpassed by hospitalizations for hypoglycemia—blood sugar that is too low—which increased by 11.7% in the same period. Hypoglycemia can cause confusion, seizures, weakness, fainting and an increased risk of death. The study, published in May in JAMA Internal Medicine, didn’t address the use of medications but “it seems the way we manage patients has resulted in these trends,” Dr. Lipska says.

Key words for you to ruminate on: Enthusiasm, Risk, Reasonable Targets, Pressure.

All this is from the onslaught of paying doctors via quality indicators.

Now my key words: Unproven, Wrong.