from self-referring nonradiologists. In 2004, this overuse was estimated to contribute to $16 billion of annual U.S. health care costs. As of a 2018 review evidence of overtreatment overmedicalization, and overdiagnosis in Pediatrics have been use of commercial rehydration solution, antidepressants, and parenteral nutrition; overmedicalization with planned early deliveries, immobilization of ankle injuries, use of hydrolyzed infant formula; and overdiagnosis of hypoxemia among children recovering from bronchiolitis. Others Hospitalizations for those with chronic conditions who could be treated as outpatients Surgeries in Medicare patients in their last year of life; regions with high levels had higher death rates Antibiotic use for viral or self-limiting infections (an overmedication that can promote antibiotic resistance) Opiate prescriptions carry the risk of addiction. In some cases, the number of pills prescribed might exceed what is actually needed for pain relief from a given condition, or a different pain management technique or medication would be effective but less risky. Many blood transfusions in the U.S. are given without checking to see if they are needed after a previous transfusion, or are given in cases where monitoring, recovering the patient's own blood, or iron therapy would be effective and reduce the risk of complications An estimated one in eight coronary stents (used in $20,000 procedures) with nonacute indications (U.S.) Stents performed by the formal chair of cardiology, Mark Midei, at St. Joseph Medical Center of Towson, Maryland Heart bypass surgeries at Redding Medical Center which resulted in an FBI raid Screening patients with advanced cancer for other cancers Annual cervical cancer screening in women with medical histories of normal pap smear and HPV test results Reduction efforts Utilization management (utilization review) has evolved over decades among both public and private payers in an attempt to reduce overuse. In this effort, insurers employ physicians to review the actions of other physicians and detect overuse. Utilization review has a poor reputation among most clinicians as a corrupted system in which utilization reviewers have their own perverse incentives (i.e., find ways to deny coverage no matter what) and in some cases are not practicing physicians, lacking real-world clinical insight or wisdom. Results of a recent systematic review found that many studies focused more on reductions in utilization than in improving clinically meaningful measures. The 2010 U.S. health care reform, the Patient Protection and Affordable Care Act, did not contain serious strategies to reduce overuse; "the public has made it