Many medical procedures could be useless or worse

By Paul Scicluna

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Most people would usually assume that new medical procedures and pharmaceutical drugs are taken on because they are better than those procedures and drugs that are currently in use. It seems that this is not always the case.

Between 2001 - 2010, each issue of The New England Journal of Medicine was reviewed by a group of scientists. There analysis found 363 studies, which examined an established clinical practice. In 146 of them the currently used medical procedure or pharmaceutical drug was shown to be no better or even worse than the one previously used.

This report showed that over 40 percent of established medical practices that were studied were found to be ineffective or even harmful, 38 percent beneficial and 22 percent unknown. This report showed that among the practices found to be ineffective or harmful were:

  • Hormone therapy in postmenopausal women
  • Intensive glucose lowering in Type 2 diabetes patients - this actually increased mortality (death)
  • High-dose chemotherapy and stem cell transplant for breast cancer - this difficult and expensive treatment was found to be no better than conventional chemotherapy

It was reported that in some instances, doctors frequently refused beneficial treatments despite a lack of evidence that they were harmful.

Dr. Prasad, chief fellow in medical oncology at the National Cancer Institute said, “Often doctors persist with procedures that lack evidence because they seem to make sense. They all sound good if you talk about the mechanisms.”

“You have cholesterol-clogged arteries, it makes sense that if you open them up it will help. But when that was studied, it didn’t improve survival.” he said.

Patients, too, like to talk about mechanisms, Dr. Prasad added. “They tend to gravitate toward the nuts and bolts — what does it do, how does it work?” he said. “But the real question is: Does it work? What evidence is there that it does what you say it does? What trials show that it actually works? You shouldn’t ask how does it work, but whether it works at all.”

The report concluded that many new techniques and medicines are either no more effective than the old ones, or worse. Moreover, many doctors persist in using practices that have been shown to be useless or harmful. “Contradicted practices don’t disappear immediately,” said the lead author, Dr. Vinay Prasad. “There’s an inertia, a 10-year period of time when the contradicted procedure continues to be practiced.”



Mayo Clinic Proceedings


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