A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices


Prasad et al. have published an analysis of 146 medical practices that had to change when they were shown to have no benefits.  A large proportion of treatments remain of unknown effectiveness or may be harmful.

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For this reason the authors favour a high barrier of validation before new practices enter widespread use.

“Recently, a project of BMJ, entitled Clinical Evidence,81 completed a review of 3000 medical practices. The project found that slightly more than a third of medical practices are effective or likely to be effective; 15% are harmful, unlikely to be beneficial, or a tradeoff between benefits and harms; and 50% are of unknown effectiveness. Our investigation complements these data and suggests that a high percentage of all practices may ultimately be found to have no net benefits. 

“To our knowledge, this is the largest and most comprehensive study of medical reversal. Previously, we have considered the causes and consequences of reversal.4-6,82 When medical practices are instituted in error, most often on the basis of premature, inadequate, biased, and conflicted evidence,4 the costs to society and the medical system are immense.5 As such, we favor policies that minimize reversal. Nearly all such measures involve raising the bar for the approval of new therapies6,83,84 and asking for evidence before the widespread adoption of novel techniques. In all but the rarest cases,82 large, robust, pragmatic randomized trials measuring hard end points (with sham controls for studies of subjective end points) should be required before approval or acceptance. Our position is in contrast to efforts to lower standards for device and drug approval,85 which further erodes the value of the regulatory process.” (emphasis added.)

The paper is further indirect endorsement of this blog’s argument that laboratory accreditation is unproven and should never have been accepted until third-parties could offer convincing evidence of its value.

Without genuinely critical research, who is going to know that accreditation is a sham?

Suitably powered proof should have come before acceptance.  Professional leaders should be ashamed of their naïveté in doing the reverse.

Image result for professional naivete

They were so convincing…I never thought something so expensive could be of such little value…

 

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