Rita Redberg: an unwavering campaigner against the harms of too much medicineBMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4390 (Published 09 August 2016) Cite this as: BMJ 2016;354:i4390
“We have been told for decades now that detecting cardiac disease early is better than waiting for symptoms to appear, which on the surface sounds reasonable. However, years of experience belies this supposed axiom, and in fact some screenings, in the guise of ‘early detection,’ can be downright dangerous,” the US cardiologist Rita Redberg wrote last month in the Wall Street Journal, in just one recent example of her attempts to educate the public on the importance of evidence to inform healthcare and the perils of too much medicine.1
Professor of clinical medicine at the University of California in San Francisco, Redberg became editor of JAMA Internal Medicine (then called Archives of Internal Medicine) in 2009.
Soon after, Redberg and another editor, Deborah Grady, discussed a vision of reducing unnecessary testing and procedures, launching the series “Less is More” followed by “Teachable Moments” in 2014, a series on the harms of medical overuse and underuse.
Unnecessary deaths from imaging
Redberg’s insistence that hard evidence should justify medical intervention has attracted critics. Indeed, some of her articles have triggered outrage. In “We are giving ourselves cancer,” an op-ed in the New York Times, Redberg and the radiologist Rebecca Smith-Bindman cited estimates from the National Cancer Institute that in a single year imaging would lead to 14 500 excess deaths from cancer over the lifetime of people exposed.2 3
“Emergency room physicians routinely order multiple computed tomography (CT) scans even before meeting a patient,” they wrote. The newspaper’s editor received more than 240 letters, including many from doctors furious at the accusation that they had been overordering scans.
But Redberg was right: 97% of 435 emergency physicians polled in 2015 admitted that they had personally ordered unnecessary imaging, largely fearing malpractice suits.3
Redberg didn’t have doctors in her family. Both of her parents had to drop out of high school to work to support their families. Her interest in medicine was spurred—during her senior year at James Madison High School—by an innovative program for New York school students to seek educational experiences.
“We got a bag of subway tokens every Monday morning,” Redberg told The BMJ. She used hers to shadow doctors at a city hospital and discovered that medicine was “a great way to combine my interest in helping people with science.”
Does this test help?
Redberg became the first in her family to finish high school, let alone college. After graduating from Cornell University with a biology degree in 1977, she attended the University of Pennsylvania Medical School, where she came under the mentorship of the health policy researcher John Eisenberg.
He was always “thinking about the big picture,” says Redberg. “One of his research studies focused on whether he could change residents’ routine ordering of daily laboratory tests for hospitalized patients. That really changed the way I looked at medicine,” she says.
“Until then, I hadn’t questioned whether someone senior to me was ordering tests that might not be necessary.”
Eisenberg “always challenged me and the house staff to think: ‘Does this test help? How will it change the outcome?’” she says.
During medical school, Redberg was awarded a fellowship to attend the London School of Economics in 1980 and 1981, where she earned a master’s degree in health policy and administration. Her thesis, signaling her later focus, was entitled “Technology assessment: cost-effectiveness analysis of heart transplant surgery in Great Britain and the US.”
While in the UK, Redberg became interested in the contrast between the US and British healthcare systems. She concluded that the US system was falling behind, especially with regard to equitable distribution. Years later, speaking in Chicago, she said, “We spend $3 trillion (£2.3 trillion; €2.7 trillion), far more than other countries, yet we still have millions and millions of people without access to healthcare.”
After completing a residency in internal medicine and a cardiology fellowship she joined her current home—the University of California at San Franscisco’s cardiovascular research center—in 1991.
Lowest life expectancies
Growing up in a household with limited finances, Redberg was always concerned with excess and waste. On the US system now, she says, “Americans have one of the lowest life expectancies in the developed world. Much of that is because we spend a lot of money on very expensive technologies that don’t lead to better patient outcomes.”
Redberg has testified in congressional hearings on balancing patient safety with innovation. Ultimately, she says, opinion pieces in newspapers cannot solve the problem of overtesting, which is incentivized by reimbursement policies, fear of malpractice suits, and other factors. These fundamental causes, she says, will have to be addressed with structural changes to meaningfully reduce overuse and overtreatment.
Provenance and peer review: Commissioned; not externally peer reviewed.
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.