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In just 6 categories of waste—overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse—the sum of the lowest available estimates exceeds 20% of total health care expenditures.

Obtaining savings directly—by simply lowering payments or paying for fewer services—seems the most obvious remedy.

Here is a better idea: cut waste.

the guideline committees that make recommendations do not appear to consider cost-effectiveness, opportunity costs, and the potential harms of decisions to broaden screening guidelines

Not only are we screening with widespread laboratory testing at younger ages, but our definition of disease is also shifting.

In BC, there has been a 13.9% increase per year in treatment rates for 8 chronic diseases, beyond what would be expected for the changing demographic characteristics of the population

national efforts to reduce inappropriate prescribing of anti-psychotic drugs, are not working as well as believed.

too often they are used to sedate care home residents and make them easier to handle.

those living in institutions were more than three times more likely to be on anti-psychotics than those living at home.

In his latest book, Seeking Sickness (Greystone Books

what have the independent experts said about the value of the screening. The United States Preventive Services Task Force is one of them. The Canadian Task Force on Preventive Health Care, that's the Canadian equivalent. Most of the stuff you see about prevention is biased. For every one site like this funded by the taxpayer with largely no conflicts of interest, there's a hundred sites that will tell you other things.

there is often little evidence they actually extend lives and in some cases they are likely to lead to more harm than good

Toronto Star Fri Aug 21 2015

As many as 60,000 North American women each year are told they have a very early stage of breast cancer - Stage 0, as it is commonly known - a possible precursor to what could be a deadly tumour. And almost every one of the women has either a lumpectomy or a mastectomy, and often a double mastectomy, removing a healthy breast as well. Yet it now appears that treatment may make no difference in their outcomes. Patients with this condition had close to the same likelihood of dying of breast cancer as women in the general population, and the few who died did so despite treatment, not for lack of it, researchers led by Dr. Steven A. Narod of the Women's College Research Institute in Toronto reported Thursday in JAMA Oncology. Working with Narod were Dr. Javaid Iqbal, Ping Sun and Victoria Sopik of Women's College and Dr. Javaid Iqbal and Vasily Giannakeas of the University of Toronto Dalla Lana School of Public Health. Their conclusions were based on the most extensive collection of data ever analyzed on the condition, known as ductal carcinoma in situ, or DCIS: 100,000 women followed for 20 years. The findings are likely to fan debate about whether tens of thousands of patients are undergoing unnecessary and sometimes disfiguring treatments for premalignant conditions that are unlikely to develop into life-threatening cancers.

The notion that most women with DCIS might not need mastectomies or lumpectomies can be agonizing for those, like Therese Taylor of Mississauga, who have already gone through such treatment. Four years ago, when she was 51, a doctor sent her for a mammogram, telling her he felt a lump in her right breast. That breast was fine, but it turned out she had DCIS in her left breast. A surgeon, she said, told her that "it was consistent with cancer" and that she should have a mastectomy. "I went into a state of shock and fear," Taylor said. She had the surgery. She regrets it. "It takes away your feeling of attractiveness," she said. "Compared to women who really have cancer, it is nothing. But the mastectomy was for no reason, and that's why it bothers me."