Choosing Wisely® in Preventive Medicine The American College of Preventive Medicine’s Top 5 List of Recommendations Catherine J. Livingston, MD, MPH, 1 Randall J. Freeman, MD, MPH, MBA, MTM&H, 2 Amir Mohammad, MD, MPH, 3 Victoria C. Costales, MD, MPH, 4 Tisha M. Titus, MD, MPH, 5 Bart J. Harvey, MD, MSc, PhD, MEd, 6 Kevin M. Sherin, MD, MPH, MBA, 7 and the Choosing Wisely s Task Force The Choosing Wisely s initiative is a national campaign led by the American Board of Internal Medicine Foundation, focused on quality improvement and advancing a dialogue on avoiding wasteful or unnecessary medical tests, procedures, and treatments. The American College of Preventive Medicine (ACPM) Prevention Practice Committee is an active participant in the Choosing Wisely project. The committee created the ACPM Choosing Wisely Task Force to lead the development of ACPM’s recommendations with the intention of facilitating wise decisions about the appropriate use of preventive care. After utilizing an iterative process that involved reviewing evidence-based literature, the ACPM Choosing Wisely Task Force developed five recommendations targeted toward overused services within the field of preventive medicine. These include: (1) don’t take a multivitamin, vitamin E, or beta carotene to prevent cardiovascular disease or cancer; (2) don’t routinely perform prostate-specific antigenbased screening for prostate cancer; (3) don’t use whole-body scans for early tumor detection in asymptomatic patients; (4) don’t use expensive medications when an equally effective and lower-cost medication is available; and (5) don’t perform screening for cervical cancer in low-risk women aged 65 years or older and in women who have had a total hysterectomy for benign disease. The Task Force also reviewed some of the barriers to implementing these recommendations, taking into account the interplay between system and environmental characteristics, and identified specific strategies necessary for timely utilization of these recommendations. (Am J Prev Med 2016;](]):]]]–]]]) & 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved. Introduction S ignificant waste exists in the U.S. healthcare delivery system. 1 Overtreatment, or overuse of healthcare services, contributes a substantial amount to the overall waste. The estimated financial cost to the U.S. healthcare system due to overtreatment in 2011 was between $158 billion and $226 billion. 2 Many efforts to increase quality and safety and lower costs of U.S. health care abound. Systemic ways to address overuse and inappropriate care have not always effectively reached consumers in a positive and timely way. A key example is when discussions of harmful or unnecessary care at the end of life devolve into discussions of “death panels.” The old adage of “more is better” is no longer applicable in evidence-based medicine. However, deter- mining what is overused and, more importantly, how to effectively communicate to providers and patients who are within a system of entrenched practices, remains a challenge. Several strategies for studying ineffec- tive services have been proposed. These strategies encourage focus on studies that will provide greatest value. Prioritization has been recommended for studying services that have a weak evidence base, entail a significant financial burden, have efficacious alternatives and known significant harms, and are likely to have strong stakeholder support. 3 From the 1 Oregon Health and Science University, Portland, Oregon; 2 U.S. Army Human Resources Command, Fort Knox, Kentucky; 3 VA Connecti- cut HCS/Yale University School of Medicine, New Haven, Connecticut; 4 New York City Department of Health, New York, New York; 5 Atlanta VA Medical Center, Decatur, Georgia; 6 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; and 7 University of Central Florida College of Medicine, Florida State University College of Medicine, Orlando, Florida Address correspondence to: Catherine J. Livingston, MD, MPH, Oregon Health and Science University, Family Medicine at Richmond, 3930 SE Division Street, Portland OR 97202. E-mail: livingsc@ohsu.edu. 0749-3797/$36.00 http://dx.doi.org/10.1016/j.amepre.2016.03.009 & 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved. Am J Prev Med 2016;](]):]]]–]]] 1