400 medical practices debunked


Almost 400 medical practices, treatments and procedures have been debunked by studies in leading medical journals, US researchers have shown.

One in ten randomised controlled trials published in the Lancet, JAMA and NEJM between 2003 and 2017 represented a ‘medical reversal’, where the outcomes were negative for an established medical practice, a review has found.

Encompassing more than 3000 journal articles , US researchers identified 396 ‘medical reversals’, representing 6% of all original articles and 13% of all randomised trials reviewed.

‘Medical reversals’ by speciality

Medical reversals were seen most often in areas of cardiovascular medicine (20%) and public health/preventive health (12%), with the most common type of interventions being medication (33%), a procedure (20%), vitamin/supplements (13%) and devices (9%).

The study authors, from the Oregon Health & Science University, said their review was one of the first to specifically look for and compile a comprehensive list of  low-value medical practices that have been found in randomised controlled trials to be no better or to be worse than a prior standard of care intervention.

While programs such as Choosing Wisely compiled brief lists of low value interventions in specific specialties, the choices were often based on consensus as much as RCTs, they said.

“We hope these findings propel medical professionals to critically evaluate their own practices and, going forward, demand high-quality research before adopting a practice, especially for practices that are costlier and/or more aggressive than standard of care,” they wrote in eLife.

“The de-adoption of these and other low-value medical practices will lead to cost savings and improvements in medical care.”

Examples of ‘medical reversals’ in the journals:

Cardiovascular

  • Omega-3 supplements to prevent cardiovascular disease.
  • Thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke.
  • Pulmonary artery catheter for patients with congestive heart failure.
  • Off-pump coronary-artery bypass grafting.

Cancer

  • Mammographic screening every 1–2 years for women ages 40–49.
  • Bevacizumab in combination with lomustine in patients with progressive glioblastoma.
  • Whole brain radiation therapy in patients with NSCLC and brain metastases.
  • Intrahepatic arterial (IHA) vs IV fluorouracil & folinic acid for patients with colorectal cancer liver metastases.

Endocrinology

  • Testosterone supplementation on improving functional mobility, cognition, and other parameters in older men.
  • HRT  for the prevention of chronic disease in postmenopausal women.
  • Screening for asymptomatic CAD in patients with type 2 diabetes.

Neurology

  • Pregabalin use for acute and chronic sciatica
  • Epidural glucocorticoid injections in patients who have lumbar central spinal stenosis and moderate-to-severe leg pain and disability.
  • PHA for slowing down cognitive and functional decline in patients with AD.

Rheumatology

  • Surgery for a meniscal tear and detected on magnetic resonance imaging (MRI) and osteoarthritis in patients 45 year of age or older.
  • Methotrexate for maintaining hearing improvement in patients with autoimmune inner ear disease.
  • Addition on TNF-inhibitors to methotrexate for active rheumatoid arthritis.
  • Hydroxychloroquine for treating symptoms of primary Sjögren syndrome.

Respiratory

  • Doubling of inhaled corticosteroid to prevent asthma exacerbation.
  • Titrated PEEP for patients with ARDS.
  • Short course patient-initiated oral prednisolone for viral wheeze in young children.
  • Universal management of asthma based on exhaled nitric oxide.

Haematology

  • Platelet transfusion to patients with hemorrhagic stroke.
  • Thromboprophylaxis with enoxaparin plus elastic stockings with graduated compression in hospitalised acutely ill medical patients.

Gastroenterology

  • ECI for the management of Crohn’s disease.
  • Percutaneous tibial nerve stimulation for faecal incontinence in adults.
  • Autologous HSCT for refractory Crohn disease.
  • Laparoscopic adhesiolysis for patients with chronic abdominal pain.

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