The Role of Professional Societies in Limiting Indication Creep

Abstract

New technology is a major driver of health care inflation. One contributor to this inflation is indication creep, the diffusion of interventions that have been proven beneficial in specific patient populations into untested broader populations who may be less likely to benefit. Professional societies sometimes promote indication creep, as we illustrate with the case of therapeutic hypothermia after cardiac arrest. Professional societies are in a unique position to limit indication creep. We propose that, at a minimum, professional societies should refrain from recommending new diagnostic and therapeutic technologies in their guidelines until they have been proven beneficial in the targeted populations. In some circumstances, professional societies could be more active in combatting indication creep, either recommending against expanded use of clinical interventions when evidence is lacking, or coordinating efforts to collect data in these broader populations.