Comprehensive review of randomized clinical trials in three medical journals reveals 396 medical reversals

One of the continuing topics in these GEITP pages is the topic of fraud and corruption in science. This investigative report [see attached article] — is today’s topic for discussion. “Low-value medical practices” are those that are either ineffective or that cost more than other options but offer only similar effectiveness. Such practices can result in physical and emotional harm to patients, undermine public trust in medicine, and result in both an opportunity cost and a financial cost. Therefore, identifying and eliminating low-value medical practices should decrease costs and improve care.

Medical reversals are one subset of low-value medical practices; these are defined as practices that have been found (through randomized controlled trials) to be no better than some prior or lesser standard of care. However, it can be difficult to identify medical reversals. One example (Cochrane reviews) provides high-quality evidence on medical practices, but each review focuses on only one practice. The Choosing Wisely Initiative in the US maintains a list of low-value medical practices, but it relies on medical organizations to report such practices; often this list includes only those practices where there is a high degree of consensus.

Authors examined more than 3,000 randomized controlled trials — published in “three leading medical journals” (J Am Med Assn, the Lancet, and N Engl J Med); authors reviewed JAMA and Lancet between 2003 and 2017, and NEJM between 2011 and 2017, and identified a total of 7,036 original articles (2,911 in JAMA; 2,624 in Lancet, and 1,501 in NEJM). There were 3,017 articles reporting the results of randomized control trials regarding a medical practice. Authors [see attached article] identified 396 medical reversals. Most of the studies (92%) were conducted on populations in high-income countries. Cardiovascular disease was the most common medical category (20%). And medication was the most common type of intervention (33%). ☹


eLife 2019; 8: e45183

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