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Groups representing hundreds of thousands of doctors are launching a new campaign that is bound to stir controversy. Their goal is to stop tests and treatments that don't do patients any good. The effort is also the support of some leading consumer groups.

As NPR's Richard Knox reports, the campaign is the first step toward limiting procedures that account for a giant chunk of the nation's medical bill.

RICHARD KNOX, BYLINE: They're calling it choosing wisely. Doctors leading the campaign say about a third of what the nation spends on health care could be done away with without harming anybody, but at this point, the campaign has more modest goals. They could add up to maybe 10 percent of current spending, or around $250 billion a year. To do that, doctors would have to cut way back on 45 common tests and procedures.

The effort was organized by the American Board of Internal Medicine Foundation. It asked specialty groups to name the top five things that patients would be better off without.

DR. JOHN SANTA: This is a good place to start, the lowest hanging fruit.

KNOX: That's Dr. John Santa of Consumer Reports, which is working with the physician groups. The list is a broad swath of everyday medical tests and procedures. For instance, most patients with back pain shouldn't get CT scans or MRIs. Neither should people with ordinary headaches or feinting spells or a child with suspected appendicitis. For that, a cheaper ultrasound will nearly always do with no radiation.

The doctors say too many patients are getting fancy cardiac workups and repeat colonoscopies, antibiotics for sinus infections, and so on.

Santa says this first set of recommendations generally doesn't get at the most controversial kinds of tests.

SANTA: You know, there are some really tough ones. Screening for breast cancer and prostate cancer. Notice these aren't chosen because those are tougher.

KNOX: But that doesn't mean the doctor groups avoid at all the difficult ones. Probably the most touchy is one put forward by the American Society of Clinical Oncologists, cancer doctors. They say most patients with advanced cancer should not get chemotherapy treatments if they're not likely to benefit.

Dr. Lowell Schnipper is a Boston oncologist who helped draw up the list.

DR. LOWELL SCHNIPPER: We are doing the vast majority of people no favor by treating them into their coffins and I think most oncologists understand that.

KNOX: Some studies indicate that 35 percent of cancer patients or more receive chemotherapy in their last two weeks of life. Schnipper says, except in rare cases, they'd be better off getting hospice care and might even live longer.

SCHNIPPER: It's highly unlikely that anything we do to people so far advanced in their illness is likely to bring them much respite.

KNOX: But that recommendation - and maybe some others - may become a lightning rod for a charge that is often raised by these discussions that this is rationing.

SANTA: We're certainly expecting it and I think we're very emphatic that we're not talking about rationing here.

KNOX: Again, that's Dr. John Santa of Consumer Reports.

SANTA: It's not denying services to people who need it. Quite the contrary, it's identifying who needs it and who doesn't, getting it right.

KNOX: There will be plenty of opportunity to debate these issues. Proponents plan to keep at it for several years and more physician and consumer groups will join the campaign this fall.

Richard Knox, NPR News.

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