(HealthDay News) — Most services included in specialty medical societies’ Top 5 lists for the Choosing Wisely campaign are based on evidence demonstrating equivalent but not superior benefit, with higher risk or higher costs compared to other options, according to a research letter published in the April 9 issue of the Journal of the American Medical Association.

Catherine Gliwa and Steven D. Pearson, MD, both from the National Institutes of Health in Bethesda, MD, analyzed the evidentiary rationales provided by specialty societies in order to assess how benefits, risks, and costs affect selection of a service for the Top 5 lists.

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The researchers found that, of the 135 services, 36% were for patient diagnosis, prognosis, or monitoring; 34% for patient treatment; and 30% for population screening. The vast majority (95%) of services had identical initial evidence categorization.

Three-quarters of services were included based on justification that adequate evidence demonstrated no additional benefit, with higher risk, higher cost, or both, compared with other options. Nearly half of the services (49%) were considered because of greater risk to patients, 24% because of higher costs, and 16% because of both greater risk and higher cost.

“We believe that specialty societies should seek greater opportunities to include within their Top 5 lists services that offer only small incremental benefits at much higher prices,” the researchers wrote.


  1. Gliwa C, Pearson SD. Evidentiary Rationales for the Choosing Wisely Top 5 Lists. JAMA. 2014;311(14):1443-1444.