To identify medical practices that offer no net benefits.
We reviewed all original articles published in 10 years (2001-2010) in one high-impact
journal. Articles were classified on the basis of whether they addressed a medical
practice, whether they tested a new or existing therapy, and whether results were
positive or negative. Articles were then classified as 1 of 4 types: replacement,
when a new practice surpasses standard of care; back to the drawing board, when a
new practice is no better than current practice; reaffirmation, when an existing practice
is found to be better than a lesser standard; and reversal, when an existing practice
is found to be no better than a lesser therapy. This study was conducted from August
1, 2011, through October 31, 2012.
We reviewed 2044 original articles, 1344 of which concerned a medical practice. Of
these, 981 articles (73.0%) examined a new medical practice, whereas 363 (27.0%) tested
an established practice. A total of 947 studies (70.5%) had positive findings, whereas
397 (29.5%) reached a negative conclusion. A total of 756 articles addressing a medical
practice constituted replacement, 165 were back to the drawing board, 146 were medical
reversals, 138 were reaffirmations, and 139 were inconclusive. Of the 363 articles
testing standard of care, 146 (40.2%) reversed that practice, whereas 138 (38.0%)
reaffirmed it.
The reversal of established medical practice is common and occurs across all classes
of medical practice. This investigation sheds light on low-value practices and patterns
of medical research.
Published by Elsevier Inc.