The next time you feel inclined to question one of your doctor's recommendations, have no doubt that you should. Sadly, you just might find yourself better off as a result of not doing what you are told.

In a recent study, Dr. Vinay Prasad of the National Institutes of Health discovered that, over the past ten years, articles published in The New England Journal of Medicine had proven many accepted medical practices ineffective. "They weren't just practices that once worked, and have now been improved upon; rather, they never worked," said Prasad. "They were instituted in error, never helped patients, and have eroded trust in medicine."


"The purpose of our investigation was to outline broad trends in medical practice and identify a large number of practices that don't work," said Prasad.

To accomplish this and to test the general standard of care, he and his colleagues reviewed a decade's worth of original articles published in the The New England Journal of Medicine, which ranks among the most prestigious peer-reviewed medical journals in the world. Specifically, the team of researchers assembled and examined 1,344 original articles published between 2001 and 2010. In particular, they focused on those articles that described a new medical practice or tested an established one; the articles they studied evaluated a screening or diagnostic test, a procedure or surgery, a medication, or any change in the way health care is systemically provided.

"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," said Prasad.

The study uncovered several disappointments that pained himself and his investigative team. For instance, slightly more than a quarter of the total articles — roughly 27 percent — tested current medical practices while the remaining 73 percent (or 981 of a total 1344) tested a new medical procedure or practice. "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," said Prasad.

Even more disheartening, of the 363 articles that tested current medical practice, Prasad and his colleagues discovered that 146 (40.2 percent) proved these practices to be ineffective, which is classified as a 'medical reversal.' Meanwhile, nearly another quarter of the tests (79 or 21.8 percent of the total) were found to be inconclusive — in other words, the medical practice could not be proven, nor for that matter disproven, to be effective.

Just over a third (38 percent of the total) of the published tests did, in fact, validate current medical practices.

Medical Reversals

"Our investigation suggests that much of what we are doing today simply doesn't help patients," said Prasad. He and his team highlighted three examples of medical reversals in particular:

  • Stenting for stable coronary artery disease was a multibillion-dollar-a-year industry when it was found to be no better than medical management for most patients with stable coronary artery disease.
  • Hormone therapy for postmenopausal women intended to improve cardiovascular outcomes was found to be worse than no intervention.
  • The routine use of the pulmonary artery catheter in patients in shock was found to be inferior to less invasive management strategies.

Other instances of medical error include use of the drug aprotinin in cardiac surgery, use of a primary rhythm control strategy for patients with atrial fibrillation, and application of recommended glycemic targets for patients with diabetes. Prasad's team found that in some cases where weak evidence for a practice exists, it may nevertheless gain acceptance "largely through vocal support from prominent advocates" and blind faith that the underlying mechanism of action is sound. Later, even after trials prove the therapy to be ineffective (or even harmful), removing the contradicted practice can prove challenging. Another surprise finding was how often a potentially beneficial therapy would be withheld because of unfounded concerns about the potential to cause harm. In this instance, Prasad cites the long-standing concern that vaccinations precipitated a flare of multiple sclerosis; many physicians neglected to practice this intervention, despite the fact that their concerns were largely undermined by the results of two separate studies in 2001.

"When medical practices are instituted in error, most often on the basis of premature, inadequate, biased, and conflicted evidence, the costs to society and the medical system are immense," wrote Prasad and his team. "Eliminating medical reversal may help address the most pressing problem in health care today."

Source: Prasad V, Vandross A, Toomey C, et al. A Decade of Reversals: An Analysis of 146 Contradicted Medical Practices. Mayo Clinic Proceedings. 2013.