146 existing medical interventions that don't work

Sometimes doing nothing is better, according to a study published in Mayo Clinic Proceedings that determined 146 contemporary medical interventions are ineffective or do more harm than good.

Researchers analyzed 1,344 original articles published in the New England Journal of Medicine between 2001 and 2010 that examined a new medical practice or tested an existing one.

Of the 363 articles that tested what doctors are doing today, 146 (40.2 percent) found these practices to be ineffective or medical reversals. According to the study, 138 (38 percent) reaffirmed the value of existing practice while 79 (21.8 percent) were inconclusive.

"A large proportion of current medical practice, 40 percent, was found to offer no benefits in our survey of 10 years of the New England Journal of Medicine," lead researcher Vinay Prasad, M.D., Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md., said Monday in an announcement.

"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," Prasad said.

The list of medical reversals includes:

  • Screening and treating for asymptomatic bacteriuria in women with diabetes--While recommended in the United States, this study found the practice did not reduce complications.
  • Anticonvulsant drugs during pregnancy--Despite doubts in medical textbooks, the study found anticonvulsants taken during pregnancy increase the risk of fetal malformation.
  • Prone positioning in ventilated patients with acute lung injury--As utilization increases, this study found no proof of prone position's survival benefit compared to the supine position.
  • Anti-arrhythmic drugs for rate and rhythm control in patients with atrial fibrillation--The study failed to prove treating patients with atrial fibrillation with costly anti-arrhythmic drugs to maintain sinus rhythm improves survival.
  • Percutaneous coronary intervention for treatment of multivessel disease--PCI has been increasingly used to treat multivessel disease but, according to the study, coronary-artery bypass grafting is still superior.

The researchers called for increased efforts to publicize knowledge about ineffective medical interventions that should be reversed and abandoned, as well requirements for stronger evidence before recommending practice guidelines.

"While the next breakthrough is surely worth pursuing, knowing whether what we are currently doing is right or wrong is equally crucial for sound patient care," Prasad said.

For more:
- here's the research announcement
- check out the study and list (.pdf)

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