A decade of reversal: An analysis of 146 contradicted medical practices

Vinay Prasad, Andrae Vandross, Caitlin Toomey, Michael Cheung, Jason Rho, Steven Quinn, Satish Jacob Chacko, Durga Borkar, Victor Gall, Senthil Selvaraj, Nancy Ho, Adam Cifu

Research output: Contribution to journalArticle

189 Scopus citations

Abstract

Objective: To identify medical practices that offer no net benefits. Methods: We reviewed all original articles published in 10 years (2001-2010) in one high-impact journal. Articles were classified on the basis of whether they addressed a medical practice, whether they tested a new or existing therapy, and whether results were positive or negative. Articles were then classified as 1 of 4 types: replacement, when a new practice surpasses standard of care; back to the drawing board, when a new practice is no better than current practice; reaffirmation, when an existing practice is found to be better than a lesser standard; and reversal, when an existing practice is found to be no better than a lesser therapy. This study was conducted from August 1, 2011, through October 31, 2012. Results: We reviewed 2044 original articles, 1344 of which concerned a medical practice. Of these, 981 articles (73.0%) examined a new medical practice, whereas 363 (27.0%) tested an established practice. A total of 947 studies (70.5%) had positive findings, whereas 397 (29.5%) reached a negative conclusion. A total of 756 articles addressing a medical practice constituted replacement, 165 were back to the drawing board, 146 were medical reversals, 138 were reaffirmations, and 139 were inconclusive. Of the 363 articles testing standard of care, 146 (40.2%) reversed that practice, whereas 138 (38.0%) reaffirmed it. Conclusion: The reversal of established medical practice is common and occurs across all classes of medical practice. This investigation sheds light on low-value practices and patterns of medical research.

Original languageEnglish (US)
Pages (from-to)790-798
Number of pages9
JournalMayo Clinic Proceedings
Volume88
Issue number8
DOIs
StatePublished - Aug 2013

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ASJC Scopus subject areas

  • Medicine(all)

Cite this

Prasad, V., Vandross, A., Toomey, C., Cheung, M., Rho, J., Quinn, S., Chacko, S. J., Borkar, D., Gall, V., Selvaraj, S., Ho, N., & Cifu, A. (2013). A decade of reversal: An analysis of 146 contradicted medical practices. Mayo Clinic Proceedings, 88(8), 790-798. https://doi.org/10.1016/j.mayocp.2013.05.012