25 Jul 2013, BioSpectrum Bureau , BioSpectrum
Singapore: 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. A new analysis published in Mayo Clinic Proceedings documents 146 contemporary medical practices that have subsequently been reversed.
A team of researchers led by Dr Vinay Prasad, Medical Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), has reviewed 10 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," said 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 percent (363/1344) of articles that tested a practice tested an established one. Instead, the vast majority of such studies, 73 percent (981/1344), tested a new medical practice. Dr Prasad said, "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 practices (40.2 percent) were found to be ineffective, or medical reversals. Another 138 (38 percent) reaffirmed the value of current practice, and 79 (21.8 percent) were inconclusive, unable to render a firm verdict regarding the practice.
Dr Prasad commented, "A large proportion of current medical practice, 40 percent, 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 added, "Healthcare 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."
Dr Prasad said, "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."