July 22, 2013
Many Medical Practices Simply Don’t Help Patients, Says Study
Susan Bowen for redOrbit.com - Your Universe Online
We typically have the expectation that newer medical practices are better than old ones, and that the procedures we undergo are the best choices for our care. Yet this expectation is sometimes unfounded. A new study published in Mayo Clinic Proceedings found that 146 currently used medical practices offer no net benefits to the patients who receive them.
A team of researchers led by Vinay Prasad, MD, of the National Institutes of Health's (NIH) Medical Oncology Branch reviewed ten years of original articles, published in the New England Journal of Medicine, that tested standards of care.
One of the things the researchers found was that only 27 percent of the articles they reviewed tested an existing medical practice. The rest, not surprisingly, tested new screening assessments, diagnostic tests, surgical procedures, etc. The researchers' concern was that unless older practices are being reviewed, health professionals may continue practices that do not work.
"The purpose of our investigation was to outline broad trends in medical practice and identify a large number of practices that don't work. Identifying medical practices that don't work is necessary because the continued use of such practices wastes resources, jeopardizes patient health, and undermines trust in medicine," explained Dr. Prasad.
The researchers used the articles to classify procedures into four categories: "Replacement" was defined as a new practice surpassing an older standard of care. "Back to the drawing board" was defined as a new practice that failed to surpass an older standard. "Reversal" was designated when a current medical practice was found to be inferior to a lesser or prior standard. "Reaffirmation" was defined as an existing medical practice being found to be superior to a lesser or prior standard. Finally, articles in which no firm conclusion could be reached were simple termed "inconclusive."
They determined that, of the 363 articles used in the study, 40.2 percent described ineffective practices, 38 percent reaffirmed the value of current procedures, and 21.8 percent were inconclusive. In discussing the 40 percent found to have been reversed, Prasad said: "They weren't just practices that once worked, and have now been improved upon; rather, they never worked. They were instituted in error, never helped patients, and have eroded trust in medicine."
The example that most people are aware of is the determination that hormone replacement therapy during menopause created more problems than it solved for many patients. Stenting for stable coronary artery disease has also been shown to be no better than medical management. Inducing hypothermia during surgery for a brain aneurysm provides no benefit and actually increases the chance for bacterial infections. And the use of impermeable bedding for asthma patients to reduce dust mite exposure has no effect. These were just a few of the examples of the costly yet useless procedures that have been employed by medical professionals across the country.
If practitioners take heed and abandon these practices, the research in these articles has served its purpose. In an editorial accompanying the research, John P. A. Ioannidis, MD, DSc, of the Stanford Prevention Research Center, urges that more research into established practices needs to be done.
"Finally, are there incentives and anything else we can do to promote testing of seemingly established practices and identification of more practices that need to be abandoned? Obviously, such an undertaking will require commitment to a rigorous clinical research agenda in a time of restricted budgets," Ioannidis wrote.
"However, it is clear that carefully designed trials on expensive practices may have a very favorable value of information, and they would be excellent investments toward curtailing the irrational cost of ineffective health care."