Still taking that medication? JAMA says your doctor might not tell you when to stop

By Arianne Cohen

Did you know that many common medical tests and treatments come with specific guidelines on how to begin and ramp up treatment—but minimal recommendations for doctors on when and how to stop? Welcome to modern medicine: Unless your doctor is particularly detail-oriented, she might not tell you to stop taking your pills. Not surprisingly, this dynamic dovetails nicely with the interests of the $1.3 trillion pharmaceutical industry, among others.

A new study in JAMA Internal Medicine (a monthly peer-reviewed medical journal published by the American Medical Association) wants to solve this problem. To the researchers’ credit, rather than parsing the matter ad nauseum, they aim to provide clear off-ramp instructions for a variety of common primary-care scenarios. Their process for creating those guidelines was complex: They gathered 409 evidence-based recommendations from medical experts, and had a 25-physician panel assess the options, ultimately recommending 37 guidelines for specific primary-care scenarios, such as:

    Older diabetes patients can often take less medication than they did when they were younger, because they no longer need to target the same low blood sugar and blood pressure numbers they held when younger

    Vitamin D deficiency is often screened for across much broader populations than needed

    Men over age 70 don’t need to be blood-tested for a specific prostate cancer marker

An accompanying op-ed notes that clinicians are widely in favor of reducing unnecessary treatments, but lack the guidelines to support those efforts.

The researchers hope that similar guidelines will eventually make their way into electronic health record systems, and that the researchers’ approach to creating the guidelines—which included a process to evaluate when and for whom treatments or tests should be scaled back—will be adopted by other fields of medicine. But systemic change takes years. In the meantime, a pro tip: Start asking your doctor about treatment exit strategies.


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