Response to JAMA Internal Medicine Commentary

The Choosing Wisely campaign was recently criticized for lacking a solid methodological approach in an editorial in JAMA Internal Medicine by Deborah Grady, Rita Redberg and William Mallon. As such, we wanted to clarify the procedures that all of our specialty society partners have followed in creating their recommendations of tests and treatments that physicians and patients should question.

Each society abided by four principles that the ABIM Foundation established as conditions for participation:

• Each recommendation must be within the control of the society’s members. (Some have criticized the number of Choosing Wisely recommendations related to subjects such as imaging and pre-operative testing. As these tests are ordered by a broad array of physicians, it should be unsurprising that these topics frequently recur on the lists.)
• Procedures should be used frequently and/or carry a significant cost.
• There should be generally accepted evidence to support each recommendation.
• The process should be thoroughly documented and publicly available upon request.

Although societies were free to use different methodologies as long as they followed these four principles, there was overwhelming consistency among the societies in how they structured their list development processes. For example, to guide the creation of their lists, the societies either established expert physician committees for the specific purpose of creating a Choosing Wisely list, or had existing committees and boards create the list. Societies also broadly relied on their clinical practice guidelines and peer-reviewed, evidence-based studies to inform their recommendations. Many societies also polled their members, outside experts or both to solicit suggestions for tests and treatments to include.

As evidence for the rigor of the process our societies used, four of the five recommendations in the emergency medicine list published in JAMA Internal Medicine were also made by specialty societies as part of Choosing Wisely.

To ensure that the process remains transparent, each society’s list of recommendations includes a “How This List Was Created” section that provides an overview of the process it used in determining its list. In addition, each individual recommendation includes citations to the scientific evidence supporting it.  On each list, the methodology section appears at the end.

We always welcome constructive feedback for Choosing Wisely, and the JAMA Internal Medicine authors include steadfast friends of the campaign. We continue to work with our society partners to ensure the rigor and usefulness of the campaign’s recommendations.

Daniel B. Wolfson
EVP and COO, ABIM Foundation