Friday, September 6, 2013

Is Science Broken? Part 6: Most Medical "Advances" Are A Waste Of Time And Money

From Dr. Eades on Twitter:
"After 65 yrs of [Random Controlled Trial]s, ineffective, harmful, expensive med practices are being introduced more freq now than ever."
He links to "How Many Contemporary Medical Practices Are Worse Than Doing Nothing or Doing Less?" [PDF] which opens:
"How many contemporary medical practices are not any better than or are worse than doing nothing or doing something else that is simpler or less expensive? This is an important question, given the negative repercussions for patients and the health care system of continuing to endorse futile, inefficient, expensive, or harmful interventions, tests, or management strategies. In this issue of Mayo Clinic Proceedings, Prasad et al describe the frequency and spectrum of medical reversals determined from a review of all the articles published over a decade (2001-2010) in New England Journal of Medicine (NEJM). Their work extends a previous effort that had focused on data from a single year and had suggested that almost half of the established medical practices that are tested are found to be no better than a less expensive, simpler, or easier therapy or approach. The results from the current larger sample of articles are consistent with the earlier estimates: 27% of the original articles relevant to medical practices published in NEJM over this decade pertained to testing established practices. Among them, reversal and reaffirmation studies were approximately equally common (40.2% vs 38%). About two-thirds of the medical reversals were recommended on the basis of randomized trials. Even though no effort was made to evaluate systematically all evidence on the same topic (eg, meta-analyses including all studies published before and after the specific NEJM articles), the proportion of medical reversals seems alarmingly high. At aminimum, it poses major questions about the validity and clinical utility of a sizeable portion of everyday medical care....

"...Despite better laboratory science, fascinating technology, and theoretically mature designs after 65 years of randomized trials, ineffective, harmful, expensive medical practices are being introduced more frequently now than at any other time in the history of medicine. Under the current mode of evidence collection, most of these new practices may never be challenged."
Emphasis mine. Read the whole thing.

Doctors are notoriously prone to jumping on the latest treatment bandwagon without waiting for valid scientific confirmation of treatment, and without following up to see if the treatment is found to be ineffective, or fraudulent.

Of course patients assume that they do. The logical course to take, therefore, since new treatments are untrustworthy, is not to take any. Take treatments that have been around for a few generations, ideally, since the effectiveness and the side-effects should be well-known, and you can double-check what your doctor is telling you to confirm that he knows what he's talking about.

If it's a life-or-death situation and a you want to take a flyer on a new treatment, fine; but be aware that that's what you're doing. For most medicines and most situations, that's not the correct approach.

(See my series Is Science Broken? and You Are The Long-Term Test for more, if you have the stomach.)