Navigation Links
Researchers identify 146 contemporary medical practices offering no net benefits
Date:7/22/2013

Rochester, MN -- While there is an expectation that newer medical practices improve the standard of care, the history of medicine reveals many instances in which this has not been the case. Reversal of established medical practice occurs when new studies contradict current practice. Reporters may remember hormone replacement therapy as an example of medical reversal. A new analysis published in Mayo Clinic Proceedings documents 146 contemporary medical practices that have subsequently been reversed.

A team of researchers led by Vinay Prasad, MD, Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, reviewed ten years of original articles published in the New England Journal of Medicine testing standard of care.

"The purpose of our investigation was to outline broad trends in medical practice and identify a large number of practices that don't work," says Dr. Prasad. "Identifying medical practices that don't work is necessary because the continued use of such practices wastes resources, jeopardizes patient health, and undermines trust in medicine."

Dr. Prasad and his investigative team evaluated 1,344 original articles published in the New England Journal of Medicine between 2001 and 2010 that examined a new medical practice or tested an established one. This included assessment of a screening, stratifying, or diagnostic test, a medication, a procedure or surgery, or any change in health care provision systems.

Dr. Prasad and colleagues made several interesting findings. First, only a minority of studies over the last 10 years even tested current medical practices. Dr. Prasad found that only 27% (363/1344) of articles that tested a practice tested an established one. Instead, the vast majority of such studies, 73% (981/1344), tested a new medical practice. Dr. Prasad says, "While the next breakthrough is surely worth pursuing, knowing whether what we are currently doing is right or wrong is equally crucial for sound patient care."

Dr. Prasad's major conclusion concerns the 363 articles that test current medical practice -- things doctors are doing today. His group determined that 146 (40.2%) found these practices to be ineffective, or medical reversals. Another 138 (38%) reaffirmed the value of current practice, and 79 (21.8%) were inconclusive -- unable to render a firm verdict regarding the practice.

Dr. Prasad comments, "A large proportion of current medical practice, 40%, was found to offer no benefits in our survey of 10 years of the New England Journal of Medicine. These 146 practices are medical reversals. They weren't just practices that once worked, and have now been improved upon; rather, they never worked. They were instituted in error, never helped patients, and have eroded trust in medicine."

Dr. Prasad adds, "Health care costs now threaten the entire economy. Our investigation suggests that much of what we are doing today simply doesn't help patients. Eliminating medical reversal may help address the most pressing problem in health care today."

Key examples of medical reversal include the following:

Stenting for stable coronary artery disease was a multibillion dollar a year industry when it was found to be no better than medical management for most patients with stable coronary artery disease. Hormone therapy for postmenopausal women intended to improve cardiovascular outcomes was found to be worse than no intervention. The routine use of the pulmonary artery catheter in patients in shock was found to be inferior to less invasive management strategies.

Other instances pertain to the use of the drug aprotinin in cardiac surgery, use of a primary rhythm control strategy for patients with atrial fibrillation, use of cyclooxygenase 2 inhibitors, early myringotomy procedures, and application of recommended glycemic targets for patients with diabetes.

Says Dr. Prasad, "To our knowledge, this is the largest and most comprehensive study of medical reversal. The reversals we have identified by no means represent the final word for any of these practices. But, the reversals we have identified, at the very least, call these practices into question."

In an accompanying editorial, John P. A. Ioannidis, MD, DSc, of the Stanford Prevention Research Center, Department of Medicine and the Department of Health Research and Policy at Stanford University School of Medicine, comments on the work of Prasad and his team and evaluates it within a broader context.

"The 146 medical reversals that they have assembled are, in a sense, examples of success stories that can inspire the astute clinician and clinical investigator to challenge the status quo and realize that doing less is more," notes Dr. Ioannidis. "If we learn from them, these seemingly disappointing results may be extremely helpful in curtailing harms to patients and cost to the health care system."

According to Dr. Ioannidis, it is just as important to promote and disseminate knowledge about ineffective practices that should be reversed and abandoned. Given the widespread attention that practice guidelines typically receive, particularly when published by authoritative individuals or groups, he questions whether a generally higher level of evidence should be required before these guidelines are recommended and can impact clinical practice.

"Finally, are there incentives and anything else we can do to promote testing of seemingly established practices and identification of more practices that need to be abandoned? Obviously, such an undertaking will require commitment to a rigorous clinical research agenda in a time of restricted budgets," concludes Dr. Ioannidis. "However, it is clear that carefully designed trials on expensive practices may have a very favorable value of information, and they would be excellent investments toward curtailing the irrational cost of ineffective health care."


'/>"/>

Contact: Rachael Zaleski
mcpmedia@elsevier.com
215-239-3658
Elsevier Health Sciences
Source:Eurekalert

Related medicine news :

1. NIH awards $20 million over 5 years to train next generation of global health researchers
2. Researchers develop a new cell and animal model of inflammatory breast cancer
3. Researchers uncover a viable way for colorectal cancer patients to overcome drug resistance
4. Researchers Find Gene Mutations That May Be a Key to Autism
5. Researchers find evidence of banned antibiotics in poultry products
6. NJ stroke researchers report advances in spatial neglect research at AAN Conference
7. Autism by the numbers: Yale researchers examine impact of new diagnostic criteria
8. Researchers Map Brain Regions Linked to Intelligence
9. Researchers ID Genes That May Determine Mental Illness
10. Researchers Develop Blood Test for Depression
11. University of Cincinnati researchers win $3.7M grant from US Department of Defense
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:4/25/2017)... ... 2017 , ... As pharmaceutical companies are held to increasingly ... innovation in drug formulation and manufacturing. CoreRx offers its clients more than ... support of their development and manufacturing goals. , The company was created ...
(Date:4/25/2017)... ... April 25, 2017 , ... Somnoware, a leading provider ... care management module. Using this new feature, sleep physicians can now predict the ... continuous positive airway pressure (CPAP), oral, or other forms of sleep apnea therapy. ...
(Date:4/24/2017)... ... April 24, 2017 , ... Emmanuel College is introducing enhancements ... their careers. Beginning in the fall of 2017, Emmanuel’s program will allow registered nurses ... as 16 months and for as little as $14,528. These changes will enable nurses ...
(Date:4/24/2017)... , ... April 24, 2017 , ... As part of ... today to honor the victims of the Holocaust and Nazi persecution, Center for ... Hadamar and Auschwitz on its CMATH Champions trip to Germany and Poland next week. ...
(Date:4/24/2017)... ... 24, 2017 , ... Sean Fay is the undisputed king of the infomercial. ... and the George Foreman Grill (which sold more than 100 million units worldwide), he ... years. , Now, due to changes in the broadcast media landscape, the once ever-present ...
Breaking Medicine News(10 mins):
(Date:4/19/2017)... LONDON , April 19, 2017 ... to stimulate an immune response in pets such ... vaccine products are of various types such as ... Vaccines, Toxoid Vaccines, DNA Vaccines and Recombinant Vaccines. ... such as virus or bacteria, which have been ...
(Date:4/18/2017)... 18, 2017  Cardinal Health (NYSE: CAH ... 2017 earnings per share (EPS) guidance and providing a ... in conjunction with this morning,s announcement of the planned ... Nutritional Insufficiency businesses. Cardinal Health now believes ... be at the bottom of its previous guidance range ...
(Date:4/18/2017)... SAN DIEGO , April 18, 2017  Astute ... previewed a case series to be presented at the ... , which begins today and continues through April 22. ... and IGFBP-7 , used to assess risk for acute ... acute decompensated heart failure (ADHF). Elevated ...
Breaking Medicine Technology: