FISCAL
Which medical interventions are worth it – Cost-effectiveness and sustainability of medical interventions?
Project timeline
Why is this initiative needed?
Health care is a force for good, but it can be overused, underused and misused. Increasing evidence from around the world shows that overdiagnosis, overtreatment, and overuse of medical treatments all have the potential to harm, but this harm has currently been largely ignored.1 2
Abandoning ineffective medical practices and mitigating the risks of untested practices are crucial for improving patient health and containing healthcare costs3. It has been estimated that at least one third (1/3) of current medical expenditure in the US is ineffective or unnecessary.4 Equally importantly, important new research findings often go unnoticed and fail to elicit changes in clinical practice (Figure below).

What is the primary objective of the FISCAL Initiative?
The FISCAL Initiative aims to shift the emphasis of healthcare toward improved decision-making and principles of evidence-based medicine to counteract systemic biases favouring entrenched practices in the face of reliable scientific evidence.5
Where are we now?
So far, we have two primary FISCAL projects:
1) Placebo-surgery controlled trials; a series of trials assessing the efficacy of some of the most common orthopaedic procedures (read more).
2) FIASCO – Is the current – osteoporosis-based – strategy for prevention of fractures viable?; a series of critical, evidence-based analyses drilling into the current practices on how people with osteoporosis or at risk of sustaining an “osteoporotic” fracture are diagnosed and treated (read more).
- Brodersen J, Kramer BS, Macdonald H, Schwartz LM, Woloshin S. Focusing on overdiagnosis as a driver of too much medicine. BMJ. 2018 Aug 17;362:k3494. doi: 10.1136/bmj.k3494.
- Brownlee S, Chalkidou K, Doust J, et al. Evidence for overuse of medical services around the world. Lancet 2017;390(10090):156-68. doi: 10.1016/S0140-6736(16)32585-5
- Prasad V, Cifu A, Ioannidis JP. Reversals of established medical practices: evidence to abandon ship. JAMA 2012;307(1):37-8. doi: 10.1001/jama.2011.1960
- Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. 2019 Oct 7. doi: 10.1001/jama.2019.13978.
- Prasad V, Ioannidis JP. Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices. Implement Sci 2014;9:1. doi: 10.1186/1748-5908-9-1
Principal investigators
News
Publications
Kari Kanto, Clare L Ardern, Jonathan W Scott, Simo Taimela, Trevor Corson, Teppo L N Järvinen
Stefan Lohmander, Teppo Järvinen
Kari Tikkinen, Jarno Rutanen, Allen Frances, Amna Maqbool, Brittany Dennis, Arnav Agarwal, Brea Perry, Shanil Ebrahim, Janne Leinonen, Teppo Järvinen, Gordon Guyatt
Tero Kortekangas, Heidi Haapasalo, Tapio Flinkkilä, Pasi Ohtonen, Simo Nortunen, Heikki-Jussi Laine, Teppo Järvinen, Harri Pakarinen
Teppo Järvinen, Gordon Guyatt
Mika Paavola, Antti Malmivaara, Simo Taimela, Kari Kanto, Teppo Järvinen
Raine Sihvonen, Martin Englund, Aleksandra Turkiewicz, Teppo Järvinen
Raine Sihvonen, Martin Englund, Aleksandra Turkiewicz, Teppo Järvinen
Teppo Järvinen
Teppo Järvinen, Karl Michaëlsson, Jarkko Jokihaara, Gary Collins, Thomas Perry, Barbara Mintzes, Vijaya Musini, Juan Erviti, Javier Gorricho, James Wright, Harri Sievänen
Teppo Järvinen, Karl Michaëlsson, Aspenberg P, Harri Sievänen
Alan Cassels, Janne Leinonen, Teppo Järvinen
Raine Sihvonen, Mika Paavola, Antti Malmivaara, Ari Itälä, Antti Joukainen, Juha Kalske, Heikki Nurmi, Teppo Järvinen
Teppo Järvinen, Jarkko Jokihaara, Pierre Guy, Pablo Alonso-Coello, Gary Collins, Karl Michaëlsson, Harri Sievänen
Raine Sihvonen, Mika Paavola, Antti Malmivaara, Teppo Järvinen
Kari Tikkinen, Janne Leinonen, Gordon Guyatt, Shanil Ebrahim, Teppo Järvinen
Raine Sihvonen, Timo Järvelä, Heikki Aho, Teppo Järvinen
Teppo Järvinen, Harri Sievänen, Pekka Kannus, Jarkko Jokihaara, Karim Khan
Henrik Ahlborg, Björn Rosengren, Teppo Järvinen, Cecilia Rogmark, Jan-Åke Nilsson, Ingemar Sernbo, Magnus Karlsson
Teppo Järvinen, Pekka Kannus, Harri Sievänen
Teppo Järvinen, Harri Sievänen, Karim Khan, Ari Heinonen, Pekka Kannus
Tero Järvinen, Teppo Järvinen, Minna Kääriäinen, Ville Aärimaa, Samuli Vaittinen, Hannu Kalimo, Markku Järvinen
Pekka Kannus, Harri Sievänen, Mika Palvanen, Teppo Järvinen, Jari Parkkari
Tero Järvinen, Teppo Järvinen, Minna Kääriäinen, Hannu Kalimo, Markku Järvinen
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