FISCAL is an international collaborative initiative led by the FICEBO to enhance the generation and penetration of trustworthy scientific information. It takes many forms, with a common goal of producing improved and more sustainable healthcare.

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).

Adapted from: Gray, J.A. Muir (1996). Evidence-based Healthcare. Churchill Livingstone.

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 orthopedic 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).

  1. Moynihan R, Heneghan C, Godlee F. Too much medicine: from evidence to action. Bmj 2013;347:f7141. doi: 10.1136/bmj.f7141
  2. 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
  3. 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
  4. Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA 2012;307(14):1513-6. doi: 10.1001/jama.2012.362
  5. 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