Elsevier

Mayo Clinic Proceedings

Volume 88, Issue 8, August 2013, Pages 790-798
Mayo Clinic Proceedings

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

https://doi.org/10.1016/j.mayocp.2013.05.012Get rights and content

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.

Section snippets

Methods

We used methods similar to our prior survey of 1 year of publications in a high-impact journal.4 We reviewed all articles under the heading “Original Articles” in the New England Journal of Medicine from 2001 to 2010. These years were the last complete 10 years when we began our investigation. Our choice of journal was made on the basis of the 5-year Hirsch index for medical journals.13 Two reviewers (C.T., A.V., M.C., J.R., S.Q., S.J.C., D.B., V.G., or S.S.) and V.P. independently extracted

Results

From 2001 through 2010, 2044 original articles appeared in one high-impact journal. Most articles (1344 [65.8%]) addressed a medical practice. A total of 981 studies (73.0%) examined a new medical practice, whereas 363 (27.0%) addressed an existing practice. During these 10 years, there were 911 (67.7%) randomized controlled trials, 220 (16.4%) prospective controlled but nonrandomized studies, 117 (8.7%) observational studies, 43 (3.2%) case-control studies, and 53 (3.9%) studies using other

Discussion

Our review of 10 years of publications in a high-impact journal involved examining 2044 articles in duplicate to identify 146 medical reversals. Reversals included medications, procedures, diagnostic tests, screening tests, and even monitoring and treatment guiding devices. We were unable to identify any class of medical practice that did not have some reversal of standard of care (Supplemental Appendix).

The bispectral index monitor (BIS) illustrates many of the principles of medical reversal.

Conclusion

We present 146 medical practices that were reversed in 10 years of publications in a high-profile journal. Our results may be of interest to practitioners and policymakers who seek to identify low-value practices and methodologists and scientists who are interested in the patterns of medical research.

Acknowledgments

The views and opinions of Dr Prasad do not necessarily reflect those of the National Cancer Institute or National Institutes of Health.

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