A new study has found that new medical practices—surgical techniques, screening processes—are often found to be ineffective based on follow-up research.
The study involved a review of articles published in Mayo Clinic Proceedings over a 10-year period and revealed that newer medical practices, regardless of how broad their usage, were reversed on evidence-based research in many cases, according to MinnPost. The findings appear in this month’s issue of the journal.
Many have long believed that newer screening technologies, surgical procedures, and medicines represent an improvement on patient care; however, this research presents a different perspective. In fact, in a video that accompanied the publication, the study’s lead author, Dr. Vinay Prasad, a medical oncologist at the National Institutes of Health (NIH), said that “of all those things we’re during currently [in medicine] that lack good evidence, probably about half of them are incorrect,” according to MinnPost.
For the study, the team reviewed 1,344 original articles that had been published in the New England Journal of Medicine between 2001 and 2010. Each published piece assessed a new or established medical practice. The team found that just 27 percent—or 363—of the studies actually tested an established medical practice, while most (73 percent or 981) studies looked at a new practice, MinnPost reported.
“While the net breakthrough is surely worth pursing, knowing whether what we are currently doing is right or wrong is equally crucial for sound patient care,” Prasad indicated in a press statement. The team also noted that articles on new practices were likelier to deem them more beneficial than articles testing existing practices. This finding, noted MinnPost, adds to mounting evidence that a positive bias exists in studies of new drugs, devices, or procedures.
Of the 363 articles that looked at existing medical practices, 146 (40.2 percent) revealed that the practices were not effective, 138 (38 percent) endorsed the practices, and 79 (21.8 percent) were inconclusive, according to MinnPost. The 146 reversals “weren’t just practices that once worked and have now been improved upon,” Prasad said “Rather, they never worked. They were instituted in error, never helped patients, and have eroded trust in medicine.” Examples include:
- Use of stents to treat stable coronary artery disease.
- Use of hormone therapy to protect post-menopausal women against heart disease
- Use of pulmonary artery catheters in patients suffering from shock
- Use of the drug aprotinin in heart surgery
- Use of COX-2 inhibitors such Celebrex and Vioxx for inflammation and pain
- Urging patients diagnosed with diabetes to maintain strict blood sugar targets
- Use of arthroscopic surgery to treat osteoarthritis of the knee
- Use of the prostate specific antigen test (PSA) in routine prostate cancer screening in older men
- Advising patients diagnosed with dust-mite allergies to purchase impermeable mattress covers
Using the mattress-cover recommendation as an example, Prasad points out in the video that this medical practice seemed to make sense on the surface, and actually prompted a $26 million-a-year industry. A set of New England Journal of Medicine papers eventually deflated the practice, according to MinnPost.
“Although there is a weak evidence based for some practice, it gains acceptance largely through vocal support from prominent advocates and faith that the mechanism of action is sound,” the team wrote. “Later, future trials undermine the therapy, but removing the contradicted practice often proves challenging.” Worse, the team noted, the practices cause people harm while they are being touted and may continue to cause harm well after being found ineffective, MinnPost noted.
“The take-away message of our paper is that a large proportion of the medical practices which are based on little to no evidence are probably incorrect,” concludes Prasad. “Their continued use jeopardizes patient health and wastes limited health care resources,” he added, according to MinnPost.