About 40% of current medical practices may be ineffective and should be reconsidered, according to a new analysis in Mayo Clinic Proceedings that reviewed 10 years of articles published in NEJM.

For the study, a team of researchers evaluated 1,344 NEJM articles published between 2001 and 2010 that examined a new or established medical practice. The articles included assessments of screening or diagnostic tests, medications, and procedures.

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Lead author Vinay Prasad was initially surprised to find that only a minority of NEJM studies—27%—over the 10 years had tested current medical practices, while 73% of articles tested a new medical practice. He says, "While the next breakthrough is surely worth pursuing, knowing whether what we are currently doing is right or wrong is equally crucial for patient care."

Of the 363 articles that tested a current medical practice:

• 40% concluded that the methods were ineffective, which the researchers referred to as "medical reversals";
• 38% reaffirmed the practice's value; and
• 22% were inconclusive.

All told, the study identified 146 medical practices that should be or have been reversed, which include:

• Administering hormone therapy for postmenopausal women;
• Stenting for stable coronary artery disease;
• Routinely installing a pulmonary artery catheter for patients in shock;
• Using the drug aprotonin during heart surgery; and
• Applying stringent glycemic targets for diabetic patients.

Prasad said the reversals found in the study "by no means represent the final word for any of these practices. But, the reversals we have identified, at the very least, call these practices into question."

Editorial urges doctors to challenge medicine's 'status quo'

In an accompanying editorial, John Ioannidis of the Stanford University School of Medicine characterized the 146 medical reversals as "examples of success stories that can inspire the astute clinician and clinical investigator to challenge the status quo and realize that doing less is more."

Ioannidis stressed the importance of promoting and disseminating knowledge about ineffective practices that should be abandoned. Continuing to question whether current medical guidelines are superior to other therapies would "be extremely helpful in curtailing harms to patients and cost to the health care system," he said (Martinez, KPCC, 7/24; Mayo Clinic Proceedings release, 7/22).