Reversal of Established Medical Practice Common

In all, the researchers reviewed 2,044 original articles. The articles were classified on the basis of whether they addressed a medical practice (73%), whether they tested a new or existing therapy (27%), and whether results were positive (70.5%) or negative (29.5%).

The articles were then classified as one of four types: replacement, when a new practice surpasses standard of care (756 articles); back to the drawing board, when a new practice is no better than current practice (165); reaffirmation, when an existing practice is found to be better than a lesser standard (138); and reversal (146), when an existing practice was found to be no better than a lesser therapy. Of the 363 articles testing standard of care, 40.2% reversed that practice, whereas 38% reaffirmed it; the rest were inconclusive. The study was published in the July 12, 2013, issue of Mayo Clinic Proceedings.

“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,” concluded lead author Vinay Prasad, MD, of Northwestern University, and colleagues. “This investigation sheds light on low-value practices and patterns of medical research.”

The history of medicine reveals numerous examples of reversal. For example, stenting for stable coronary artery disease was a multibillion dollar a year industry when it was found to be no better than medical management for most patients; hormone therapy for postmenopausal women intended to improve cardiovascular outcomes was found to be worse than no intervention; and the routine use of the pulmonary artery catheter in patients in shock was found to be inferior to less invasive management strategies.


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Northwestern University

US National Cancer Institute