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How Many Contemporary Medical Practices Are Worse Than Doing Nothing or Doing Less?

  • John P.A. Ioannidis
    Correspondence
    Correspondence: Address to John P. A. Ioannidis, MD, DSc, Stanford Prevention Research Center, Medical School Office Bldg Rm X306, 1265 Welch Rd, Stanford, CA 94305.
    Affiliations
    Stanford Prevention Research Center, Department of Medicine, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
    Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA
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      How many contemporary medical practices are not any better than or are worse than doing nothing or doing something else that is simpler or less expensive? This is an important question, given the negative repercussions for patients and the health care system of continuing to endorse futile, inefficient, expensive, or harmful interventions, tests, or management strategies. In this issue of Mayo Clinic Proceedings, Prasad et al
      • Prasad V.
      • Vandross A.
      • Toomey C.
      • et al.
      A decade of reversal: an analysis of 146 contradicted medical practices.
      describe the frequency and spectrum of medical reversals determined from a review of all the articles published over a decade (2001-2010) in New England Journal of Medicine ( NEJM). Their work extends a previous effort
      • Prasad V.
      • Gall V.
      • Cifu A.
      The frequency of medical reversal.
      that had focused on data from a single year and had suggested that almost half of the established medical practices that are tested are found to be no better than a less expensive, simpler, or easier therapy or approach. The results from the current larger sample of articles
      • Prasad V.
      • Vandross A.
      • Toomey C.
      • et al.
      A decade of reversal: an analysis of 146 contradicted medical practices.
      are consistent with the earlier estimates: 27% of the original articles relevant to medical practices published in NEJM over this decade pertained to testing established practices. Among them, reversal and reaffirmation studies were approximately equally common (40.2% vs 38%). About two-thirds of the medical reversals were recommended on the basis of randomized trials. Even though no effort was made to evaluate systematically all evidence on the same topic (eg, meta-analyses including all studies published before and after the specific NEJM articles), the proportion of medical reversals seems alarmingly high. At a minimum, it poses major questions about the validity and clinical utility of a sizeable portion of everyday medical care.

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      Linked Article

      • Reversal of Medical Practices
        Mayo Clinic ProceedingsVol. 88Issue 10
        • In Brief
          We recently read with great interest “A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices” by Prasad et al,1 along with the accompanying editorial by Ioannidis.2 The authors have done an admirable job of quantitatively analyzing the number of reversals published over a decade in one high-impact journal, of course begging the question of how many reversals might be found across the medical literature. We would like to raise 2 important points. The first is about dissemination of the finding of reversal.
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