Not everything that the doctor prescribes works because a large number of practices adopted by doctors are backed by insufficient research. A team of scientists from several universities in the U.S. has analysed 3,000 studies and identified 396 “medical reversals” among them. Reversals mean accepted practices which are found to be ineffective by later trials. These 3,000 studies were taken from the Journal of the American Medical Association, the Lancet, and the New England Journal of Medicine.
“Medical reversals are a subset of low-value medical practices and are defined as practices that have been found, through randomized controlled trials, to be no better than a prior or lesser standard of care,” says the study published in the journal eLife. These 396 reversals, which add to the previous research in this field, had been practiced and tested in high-income as well as low- to middle-income countries, although the highest percentage of reversals was in high-income countries.
“Many reversals involved practices where the physician was a ‘gatekeeper’ to access these practices, but some were practices where the patient could access on their own, such as behavioral practices (e.g., cognitive behavioral therapy or mindfulness interventions), complementary or non-traditional practices (e.g., acupuncture), dietary supplements (e.g. omega-3 fatty acids or vitamin A supplementation), community practices (e.g., programs to prevent teenage pregnancy or self-poisoning), or wearable technology,” says the study.
These scientists say that low-value medical prctices such as medical reversals can result in physical and emotional harm, undermine public trust in medicine, and have both an opportunity cost and a financial cost. Identifying and eliminating low-value medical practices would reduce costs and improve care, they add.
Most of the 396 medical reversals (20 per cent) were in the category of cardiovascular diseases, followed by public health/preventive medicine (12 per cent) and critical care (11 per cent). Regarding the type of medical intervention, medication was the most common category (33 per cent), followed by a procedure (20 per cent), vitamin/supplement (13 per cent), device (9 per cent) and system intervention (8 per cent). You can read the Selected reversal summaries here.
The study says a previous research approximated the financial costs of 26 low-value services that are more commonly used in the older adult population. The research estimated that spending for these services in the Medicare population was between $1.9 billion and $8.5 billion during 2008–2009, which was between 0.6% and 2.7% of Medicare Parts A and B spending. At least 25% of Medicare beneficiaries received low-value services during 2008–2009.
“We hope these findings propel medical professionals to critically evaluate their own practices and, going forward, demand high-quality research before adopting a practice, especially for practices that are costlier and/or more aggressive than standard of care,” say the scientists who were led by Vinay Prasad of Oregon Health & Science University, Portland, United States.