Article Critique: Hensher et al. (2017) - Too Much Medicine

This report provides a critical analysis of the peer-reviewed journal article by Hensher et al. (2017), which explores the phenomenon of "too much medicine" and the overconsumption of healthcare resources. The report examines the authors' central argument that healthcare professionals may prescribe unnecessary diagnoses and interventions due to perverse incentives, positional competition, and cognitive biases, potentially causing patient harm. It supports the argument by drawing on research from health economics, behavioral economics, and ecological economics. The critique highlights the authors' conclusion that addressing overconsumption requires interdisciplinary collaboration, cultural change, and amendments to healthcare policies. The report also acknowledges the significance of competitive and positional consumption, along with cognitive biases, in contributing to the overall overconsumption, and emphasizes the need for policy changes and initiatives by healthcare leaders and managers to prevent unnecessary medical interventions and improve patient care.

Running head: ARTICLE CRITIQUE
ARTICLE CRITIQUE
Name of the student:
Name of the university:
Author note

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Introduction:
In the current era, the general phenomenon of needless diagnoses and interventions given
to patients not only reduce care value nut also patients were exposed to high risk which disrupts
their quality of life (Jansen et al. 2018, i2893). While some of the theorists justified it as a
rationale choice for clinical decision making, few of the researchers also highlighted the presence
of positional competition and status. To prevent this unnecessary clinical behavior, a movement
was adopted which was labeled as “too much medicine”. If the additional resources failed to
confer benefits to the patients, then there must be some economic benefits that influence the
clinical behavior of the professionals (Theuretzbacher et al. 2017, 1). Hence, this paper intended
to provide critical analysis of a peer review journal Hensher et al. (2017) with the support of
other documented literature in the following paragraphs.
Discussion:
Argument of researchers:
The purpose of the author was to in-depth literature review for identifying definitions as
well as characteristics of diverse forms of overconsumption of healthcare and reason behind
unnecessary investigations and intervention which expose patients into greater harm (Hensher et
al. 2017, 80). The central argument of the authors was health care professionals were not acting
as a perfect agent for curing the patients rather they tend to prescribe unnecessary diagnosis and
interventions which confer no benefit to the patients and also subject patients to greater harm
(Hensher et al. 2017, 80). The author argued that there may be perverse incentives received by
the professionals regarding the unnecessary investigation as strong evidence is present for
supplier induced demand and various financial incentives. The author concluded that while

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some of the professionals consider these unnecessary investigations as a rationale choice for
appropriate decision making of patients, some of the health professional’s exhibit this behavior
due to the positional competition (Hensher et al. 2017, 80). The researchers also consider it
a cognitive bias for the professionals in decision making. The researchers clearly stated the
argument. In order to justify the argument, the researchers provided point view of other authors
documented in the literature and figure. Another study highlighted that the effectiveness of
providing data in the form of figure and tabular format is that the information can be easily read
through and it is visually appealing to the readers (Hensher et al. 2017, 80). Hence, the argument
was accurately presented. Moreover, in order to support the argument made by authors, the
authors draw in-depth research from health economics, behavioral economics, and ecological
economics to identify possible explanations for and drivers of overconsumption. Drawing
research from the different field not only improve the credibility of the research but also of
increase dynamicity of the research (Almalki et al. 2016, 290). Hence, in order to the validity of
the research, it is crucial to draw information from different field and analyses it.
Argument expected to find:
The author argued that there may be perverse incentives received by the
professionals regarding the unnecessary investigation which drive them to make an unnecessary
intervention and prescribe unnecessary diagnosis as strong evidence is present for supplier
induced demand and various financial incentives. To support the argument, the researchers with
the support of behavioral economics highlighted the role of biases such as belief perseverance,
confirmation bias, hindsight bias and overconfidence behind overuse of medicine (Hensher et al.
2017, 80). The similar kind of argument was also made by Scott et al. (2017) where researchers

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highlighted influences of cognitive biases in the clinical decision making which further
drive professionals to overuse the medication and unnecessary interventions. A significant
number of professional’s prescribe excessive medicine and diagnosis with the intuition that it
will facilitate clinical decision making. The researchers also highlighted the role of competitive
and positional consumption behind this aggregate overconsumption. Different brands of drug
demand to sell their product through the physicians to improve their social status and position
and in return, the physicians may receive financial incentives. On the other hand, a greater role
for status or positional component or jealousy between professionals is also driving for
overconsumption of health care. it is not impossible to see that how professionals might perceive
their prestige in the society through their ability to offer the best possible technology or
medication despite it was unnecessary for certain patients. With the assistance of standard
economic theory, the authors also highlighted that the same strategy is implemented by the
health care market. Similar kind of statement was made by other researchers where study
highlighted that while high and continuously rising drug prices along with overuse of medication
are justified as the scientific innovation, demand to allocate the drugs, establish a position in the
consumer market is the crucial driving force (Lee Mendoza, Roger 2019, 7). While all
arguments were made by researchers were justified, the researchers failed to address the potential
harm of the overuse in details. It is crucial to show the effect of overuse in patients to justify the
reduction of overuse of the medication (Lindblad et al. 2017, 5)
Author’s conclusion:
In conclusion, the author concluded that incentives received by the professionals
regarding the unnecessary investigation and cognitive biases for potential decision making drive
them to make an unnecessary intervention and prescribe unnecessary diagnosis. In order to

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address the issue of interdisciplinary collaboration, cultural change and amendments of health
care policies are essential. The implication of this in that health leadership and management, this
research will provide a direction to the leaders to identify the possible reason behind
overconsumption and potential harm experienced by patients (Bokhour et al. 2018, 168). It will
also help health care management to change the culture of health care by amending policies,
restricting unnecessary supply chain demand for similar drugs. Consequently, the health care
leaders would be able to use it as a quality improvement initiatives for providing the best
possible care without exposing the patient to potential harm.
Conclusion:
In concluding note, it can be said that competitive and positional consumption along
with cognitive bias played a crucial role behind aggregate overconsumption which causes
potential harm to the patients. To address the issue, amendments of health care policies, a ban
on unnecessary demand are crucial. The health care leaders and managers can take initiatives for
preventing “too much medicine”.

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References:
Almalki, Sami. "Integrating Quantitative and Qualitative Data in Mixed Methods Research--
Challenges and Benefits." Journal of Education and Learning 5, no. 3 (2016): 288-296.
Bokhour, Barbara G., Gemmae M. Fix, Nora M. Mueller, Anna M. Barker, Sherri L. Lavela,
Jennifer N. Hill, Jeffrey L. Solomon, and Carol VanDeusen Lukas. "How can healthcare
organizations implement patient-centered care? Examining a large-scale cultural
transformation." BMC health services research 18, no. 1 (2018): 168.
Hensher, Martin, John Tisdell, and Craig Zimitat. "“Too much medicine”: Insights and
explanations from economic theory and research." Social Science & Medicine 176 (2017): 77-84.
Jansen, Jesse, Vasi Naganathan, Stacy M. Carter, Andrew J. McLachlan, Brooke Nickel, Les
Irwig, Carissa Bonner et al. "Too much medicine in older people? Deprescribing through shared
decision making." Bmj 353 (2016): i2893.
Lee Mendoza, Roger. "Incentives and disincentives to drug innovation: evidence from recent
literature." Journal of Medical Economics (2019): 1-9.
Lindblad, Staffan, S. Ernestam, A. D. Van Citters, C. Lind, T. S. Morgan, and E. C. Nelson.
"Creating a culture of health: evolving healthcare systems and patient engagement." QJM: An
International Journal of Medicine 110, no. 3 (2017): 125-129.
Losby, Jan L., Joel D. Hyatt, Michael H. Kanter, Grant Baldwin, and Denis Matsuoka. "Safer
and more appropriate opioid prescribing: a large healthcare system's comprehensive
approach." Journal of evaluation in clinical practice 23, no. 6 (2017): 1173-1179.
McCusker, Kevin, and Sau Gunaydin. "Research using qualitative, quantitative or mixed
methods and choice based on the research." Perfusion 30, no. 7 (2015): 537-542.

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Scott, Ian A., Jason Soon, Adam G. Elshaug, and Robyn Lindner. "Countering cognitive biases
in minimising low value care." Medical Journal of Australia 206, no. 9 (2017): 407-411.
Theuretzbacher, Ursula, Christine Årdal, and Stephan Harbarth. "Linking sustainable use
policies to novel economic incentives to stimulate antibiotic research and
development." Infectious disease reports 9, no. 1 (2017).