Source: Thailand Medical News Nov 10, 2019 5 years, 1 week, 5 days, 2 hours, 40 minutes ago
A simple study involving randomly checking doctors in Asia about their knowledge of
medical reversals by
asking them questions on a few medical protocols revealed a disturbing trend that most were not aware of some of these medical reversals.
"
Medical reversal" is a term that defines instances in which new and improved clinical trials show that current medical practices are ineffective or misguided. New research reveals that there are currently almost 396 medical reversals.
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.
Dr 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.
Referring to well-known endeavors to assess the validity of clinical practices, such as the Cochrane reviews, Dr Herrera-Perez told
Thailand Medical News "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."
Embarking on the process, 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 data analysis discovered 396
medical reversals: 154 of them in
JAMA, 129 in
NEJM, and 113 in
The Lancet.
A majority of these new findings were done by 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.
A bulk of the
medical reversals occurred in the fields of cardiovascular disease (20%), public health and preventive medicine (12%), and critical care (11%).
The most common interventions involved medications (33%), procedures (20%), vitamins and supplements (13%), devices (9%), and system interventions (8%).
Dr. Vinay P
rasad, the study's senior author, , 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. We hope our broad results may serve as a starting point for researchers, policymakers, and payers who wish to have a list of practices that likely offer no net benefit to use in future work."
Dr. Prasad cautions that the review has some limitations, such as the small number of journals it includes and the limited expertise of the reviewers. To overcome such limitations, co-lead study author Alyson Haslam, Ph.D., who is also affiliated with the OHSU Knight Cancer Institute, calls for experts from various fields to critically assess the medical reversals identified in the analysis.
Alyson Haslam commented "Taken together, we hope our findings will help push medical professionals to evaluate their own practices critically and demand high-quality research before adopting a new practice in the future, especially for those that are more expensive and/or aggressive than the current standard of care."
Thailand Medical News however, after conducting its own survey of tasking doctors from countries like Vietnam, Malaysia, China, India, Thailand, Indonesia, Philippines etc with regards their knowledge about a few of these medical reversals was disturbed by the outcome.
In some of these countries, a platform or even a way of incorporating updates into existing CDS (Clinical Decision Support) tools or simply by holding a compulsory bi yearly CME program to educate doctors in specific fields about progress, changes and developments in their field is critically needed.
In addition, doctors’ licenses should be periodically reviewed and doctors should be made to take a test at least every two years in order to maintain their license to practice as the field of medicine is progressing rapidly and changing day by day.
References:
Meta-Research: A comprehensive review of randomized clinical trials in three medical journals reveals 396 medical reversals eLife 2019;8:e45183 DOI: 10.7554/eLife.45183 , https://elifesciences.org/articles/45183
Medical Reversal: Why We Must Raise the Bar Before Adopting New Technologies
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3238324/
