The enthusiasm factor is widespread, as Dr. Mark Chassin, CEO of The Joint Commission, reminds us. Even when evidence proves that an intervention is not effective, enthusiasm for it overwhelms objectivity. A case in Maryland of unnecessary stents involving nearly 600 people illustrates this phenomenon. A physician who assumed responsibility for the care of some of these patients, after the doctor involved stopped practicing, said that a small subset still believed that the physician who performed the unnecessary procedures saved their lives. The enthusiasm factor is alive and well because of what I call "the marinated mind." Our minds have been marinated by the media and marketing to believe that more is better. We need to dilute the marinade.
Finally, publicly-traded companies that sell drugs, devices, and equipment are a powerful driver of overuse. Their primary fiduciary duty is to shareholders and they are obligated to maximize shareholder value. This goal can be achieved only by selling more products and increasing the price. Selling more requires doctors to use more of their products in surgeries, tests, and prescribing practices.