CLEVELAND, Ohio -- Doctors and patients should question the use of feeding tubes in people with advanced

,

for convenience in patients who aren't critically ill and

before 39 weeks of pregnancy if they aren't medically necessary.

Those procedures are on a list of 90 commonly ordered tests and other medical treatments doctors say are not always necessary and could cause harm.

The list was released early today by the American Academy of Family Physicians and the 16 other medical societies that compiled them.

The 90 treatments join 45 other questionable ones that physician organizations announced last year as part of the Choosing Wisely campaign organized by the American Board of Internal Medicine Foundation.

Consumer Reports and more than a dozen partners, such as AARP, will work to inform the public of the expanded list. At the same time, the medical societies will educate the more than 725,000 physicians in their organizations about them.

"The American public needs to have conversations in the community, in organizations, where they work and with their physicians about what is appropriate care and that more care is not always better," said Daniel Wolfson, executive vice president of the internal medicine foundation.

"That is the cultural revolution we are trying to instill here."

Wolfson said the foundation wants to make sure patients are aware of tests and procedures that have little or no value so they don't ask for them.

But he made it clear that the tests are essential in some cases.

"They're recommendations, they're not absolutes," Wolfson said in a telephone interview.

"The big message is we want informed conversation between patients and physicians, conversations about unnecessary tests and procedures.

"We're having a shift in American medicine about how care is delivered and what we recognize as value. We think if quality is better, safety is better, we remove waste and we reduce costs. But reducing costs is a byproduct, not a goal, of this campaign."

Choosing Wisely appears to be working.

A Consumer Reports survey found that 72 percent of those who received information about the campaign said it prompted them to ask more questions, changed their opinion or taught them something new.

Many of the questionable treatments, explained in nonmedical terms in English and Spanish, will be available on the Consumer Reports website, tinyurl.com/consumerreportschoosingwisely. They'll be posted gradually over the next few months as they're translated into simpler language. More technical versions of all the procedures and tests that should be discussed first, written for healthcare workers, can be found immediately at choosingwisely.org.

Additional recommendations are on the way.

Twelve more medical societies will release their lists of questionable treatments later this year. And three others will add to lists they've already released.

Included on the list released today are:

• Routinely performing annual PAP tests for women 30 to 65 years old.

• Prescribing antipsychotic medication as a first choice to treat behavioral and psychological symptoms of dementia.

• Prescribing testosterone in men with erectile dysfunction and normal testosterone levels.

• Screening healthy people -- with no symptoms -- for cancer using a PET/CT scan.

• Treating an elevated PSA in men with antibiotics when no other symptoms are present.

• Prescribing Xanax, Valium, Ativan, and other drugs known as benzodiazepines in older patients as a first choice for insomnia, agitation or delirium.

Wolfson recommends that patients print out the lists and take them along when they visit their doctor. Because they are broken down by medical specialty, a patient visiting a dermatologist, for example, can print only the dermatology list and not all 135 recommendations.