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Thursday, April 21, 2016

The Science of Choosing Wisely — Overcoming the Therapeutic Illusion

David Casarett
New England Journal of Medicine 2016; 374:1203-1205
March 31, 2016
DOI: 10.1056/NEJMp1516803

Here are two excerpts:

The success of such efforts, however, may be limited by the tendency of human beings to overestimate the effects of their actions. Psychologists call this phenomenon, which is based on our tendency to infer causality where none exists, the “illusion of control.” In medicine, it may be called the “therapeutic illusion” (a label first applied in 1978 to “the unjustified enthusiasm for treatment on the part of both patients and doctors”). When physicians believe that their actions or tools are more effective than they actually are, the results can be unnecessary and costly care. Therefore, I think that efforts to promote more rational decision making will need to address this illusion directly.


The outcome of virtually all medical decisions is at least partly outside the physician’s control, and random chance can encourage physicians to embrace mistaken beliefs about causality. For instance, joint lavage is overused for relief of osteoarthritis-related knee pain, despite a recommendation against it from the American Academy of Orthopedic Surgery. Knee pain tends to wax and wane, so many patients report improvement in symptoms after lavage, and it’s natural to conclude that the intervention was effective.

The article is here.