A new meta-analysis finds that almost 400 medical practices may not be effective.
Medical reversals occur when new clinical research shows that a certain medical practice does not, in fact, work or it does more harm than good.
These new studies are superior to their predecessors because of things like better controls, better study design, or larger sample size.
Medical reversals often concern medications but they can also affect surgical procedures.
For instance, more than a decade ago, researchers and healthcare professionals realized that stenting procedures did not work for renal artery stenosis and that routine stenting should not be used to treat stable coronary disease.
Now, a new meta-analysis of 3,000 studies identifies almost 400 cases of medical reversals. The review appears in the journal eLife.
Diana Herrera-Perez, a research assistant at the Knight Cancer Institute at Oregon Health & Science University (OHSU), in Portland, is the lead author of the new analysis.
Analysis finds 396 medical reversals
Referring to well-known endeavors to assess the validity of clinical practices, such as the Cochrane reviews, Herrera-Perez says, “We wanted to build on these and other efforts to provide a larger and more comprehensive list for clinicians and researchers to guide practice as they care for patients more effectively and economically.”
To do so, she and colleagues examined over 3,000 randomized controlled trials published in three prestigious medical journals over the last 15 years: The Journal of the American Medical Association (JAMA), The Lancet, and The New England Journal of Medicine (NEJM).
The analysis discovered 396 medical reversals: 154 of them in JAMA, 129 in NEJM, and 113 in The Lancet.
Researchers carried out most of these studies (92%) in high-income countries, while 8% were performed in low- or middle-income countries, including China, India, Malaysia, Ghana, Tanzania, and Ethiopia.
Most of the medical reversals occurred in the fields of cardiovascular disease (20%), public health and preventive medicine (12%), and critical care (11%).
Specifically, the most common interventions involved medications (33%), procedures (20%), vitamins and supplements (13%), devices (9%), and system interventions (8%).
Main takeaways from the results
The study’s senior author, Dr. Vinay Prasad, a hematologist-oncologist and associate professor at the OHSU Knight Cancer Institute, comments on the findings.
“There are a number of lessons that we can take away from our set of results, including the importance of conducting [randomized controlled trials] for both novel and established practices,” he says.