An Unexpected Reaction to Choosing Wisely® List at #ASTRO2013

I had the honor of speaking at the American Society for Radiation Oncology’s (ASTRO) annual meeting in Atlanta, Georgia on September 23. One of the goals of my session was to announce ASTRO’s Choosing Wisely list of five tests and procedures that patient and physicians should question. Actually, Michael Steinberg, MD, chair of the board of ASTRO, was announcing the five things – I was just the opening act. It was a full house, standing-room-only in a large narrow rectangular room with probably more than 600 people. There was excitement and anticipation in the air; the list had been kept confidential until this moment.

I was there to introduce the Choosing Wisely campaign and the impetus behind the effort. As in most of my talks, I use the opportunity to elucidate the connection between the campaign and medical professionalism:

• Placing the best interest of patients above economic self-interest
• Refocusing on the patient-physician relationship and patient-centered care
• Removing waste from the system

As I prepared for this particular event, I came across a quote I had written down in 2006, which I read before the packed house that day:

“The true professional is one who strips away all illusions to reveal a reliable truth in which the human heart can rest.” Parker Palmer, Active Life

After I spoke, Dr. Steinberg revealed the items on ASTRO’s Choosing Wisely list. One that particularly attracted my eye and others’ was:

Don’t routinely recommend proton beam therapy for prostate cancer outside of a prospectively clinical trial or registry.

• There is no clear evidence that proton beam therapy for prostate cancer offers any clinical advantage over other forms of definitive radiation therapy. Clinical trials are necessary to establish a possible advantage of this expensive therapy.

That very day, on my way to the conference, I saw a huge construction site for a new proton beam therapy unit. I thought of that site at that moment. Then I recalled a blog post I had written about the dangers of direct–to-consumer advertising of proton beam therapy by an academic medical center.

After the list was revealed, a physician from an academic medical center in a West Coast city got up and referred to the proton beam therapy recommendation. He stated that his institution was the latest to install a proton beam therapy facility. I braced for what I assumed could only be criticism. But then he stated:  “I am glad this recommendation has come out – it is the right recommendation.”

Holy cow – the right thing to do! Now that’s professionalism in all its glory. Congratulations to ASTRO for being courageous and bold, and its members who uphold the tenets of medical professionalism so well.

Daniel B. Wolfson
EVP and COO, ABIM Foundation