A comprehensive review of randomized clinical trials in three medical journals reveals 396 medical reversals.

Diana Herrera-Perez,Alyson Haslam,Vinay Prasad,Catherine Livingston,Michael Hayes,Adam S Cifu,Dan Morgan,Jennifer Gill,Victoria Kaestner,Tyler Crain

doi:10.7554/elife.45183

Abstract

The ability to identify medical reversals and other low-value medical practices is an essential prerequisite for efforts to reduce spending on such practices. Through an analysis of more than 3000 randomized controlled trials (RCTs) published in three leading medical journals (the Journal of the American Medical Association, the Lancet, and the New England Journal of Medicine), we have identified 396 medical reversals. Most of the studies (92%) were conducted on populations in high-income counties, cardiovascular disease was the most common medical category (20%), and medication was the most common type of intervention (33%).

Highlights

Low-value medical practices are medical practices that are either ineffective or that cost more than other options but only offer similar effectiveness (Prasad et al, 2013; Prasad et al, 2011; Schpero, 2014)
We reviewed Journal of the American Medical Association (JAMA) and the Lancet between 2003 and 2017, and New England Journal of Medicine (NEJM) between 2011 and 2017, and identified a total of 7036 original articles
Aim of study We sought to compile a list of medical reversals that appeared in three leading general medical journals during a 15 year period

Summary

Introduction

Low-value medical practices are medical practices that are either ineffective or that cost more than other options but only offer similar effectiveness (Prasad et al, 2013; Prasad et al, 2011; Schpero, 2014). Medical reversals are a subset of low-value medical practices and are defined as practices that have been found, through randomized controlled trials, to be no better than a prior or lesser standard of care (Prasad et al, 2013; Prasad et al, 2011). It can, be difficult to identify medical reversals. The Choosing Wisely initiative in the US maintains a list of low-value medical practices, but it relies on medical organizations to report such practices and often includes only those practices where there is a high degree of consensus (Beaudin-Seiler, 2016)

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Discussion

Conclusion