Blog | Wednesday, July 24, 2013

QD: News Every Day--Many 'medical advances' eventually overturned


Offering no treatment can still be the best option a physician has, because the latest and greatest in medical advances are so often later discovered to be no better than doing nothing, a study concluded.

Reviewers classified all original articles that tested a new medical practice or therapy published from 2001 to 2010 in the New England Journal of Medicine into four types: "replacement," a new practice that surpasses standard of care; "back to the drawing board," a new practice that is no better than current practice; "reaffirmation," an existing practice that is better than a lesser standard; and "reversal," an existing practice that is no better than a lesser therapy.

Results appeared in the Mayo Clinic Proceedings.

In the study, about 40% of the studies that tested an existing medical practice found it ineffective compared with a previous standard, 38% upheld the practice, and about 27% were inconclusive.

Authors noted that this study, along with similar efforts such as the projects done by medical journals and medical societies, supports the idea that many "advances" are eventually overturned.

Researchers wrote, "The reversals we have identified by no means represent the final word for any of these practices. Simply because newer, larger, better controlled or designed studies contradict standard of care does not necessarily mean that older practices are wrong and new ones are right. On average, however, better designed, controlled, and powered studies reach more valid conclusions. Nevertheless, the reversals we have identified at the very least call these practices into question. Some practices ought to be abandoned, whereas others warrant retesting in more powerful investigations. One of the greatest virtues of medical research is our continual quest to reassess it."

An accompanying editorial outlined the impact of these results across not just one journal but across all of them.

"Despite better laboratory science, fascinating technology, and theoretically mature designs after 65 years of randomized trials, ineffective, harmful, expensive medical practices are being introduced more frequently now than at any other time in the history of medicine. Under the current mode of evidence collection, most of these new practices may never be challenged," the author wrote.

But there's hope if clinicians review the medical reversals and realize that the urge to treat isn't always the right choice.

The editorial continued, "The data collected by Prasad et al offer some hints about how this dreadful scenario might be aborted. 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. It is not with irony that I call these disasters 'success stories.' If we can learn from them, these seemingly disappointing results may be extremely helpful in curtailing harms to patients and cost to the health care system."