It’s human nature to assume that new often means better. But in the case of medical treatments, that’s not always the case. In a new systematic review published in the Mayo Clinic Proceedings, researchers reviewed 10 years of previous issues of the New England Journal of Medicine to identify the benefits of various medical practices which were described.
The researchers identified a total of 1,344 articles presenting evidence about medical practices . Seventy-three percent examined new medical practices and 27 percent examined existing medical practices.
In 56 percent of the studies, the new medical practice yielded better results compared to the current standard of care. In 12 percent, the new practice was no better than the current practice. And in nearly 11 percent of the studies, the new medical practice was found to be no better or worse than the current practice.
In addition, 363 of the studies tested a standard of care – an established medical treatment widely-accepted as the best method to treat a specific condition. More than 40 percent of these studies found the current established medical practice to be ineffective or harmful.
Among the practices found to be ineffective or harmful were the use of hormone therapy in postmenopausal women; the use of allergen-impermeable bed covers for adults with asthma; genetic screening before implantation for women undergoing invitro-fertilization; and intensive glucose lowering in Type 2 diabetes patients in intensive care, which not only failed to reduce cardiovascular events but actually increased mortality.
The bottom line, according to the study authors, is that patterns of medical practice often persist despite the evidence.
“Contradicted practices don’t disappear immediately,” lead author Dr. Vinay Prasad told the New York Times for an article about the review. “There’s an inertia, a 10-year period of time when the contradicted procedure continues to be practiced.”
“(Patients) tend to gravitate toward the nuts and bolts — what does it do, how does it work?” he said. “But the real question is: Does it work? What evidence is there that it does what you say it does? What trials show that it actually works? You shouldn’t ask how does it work, but whether it works at all.”
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