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An editorial in JAMA, Jan 4, 2012, deplores the persistent promotion of outmoded medical practices, in the guise of being valid.  (Reversals of Established Medical Practices, pp37-38)

Modern medicine presents itself as being “evidence-based,” meaning that its tests and therapies are proven by research to be valid.  Unfortunately for patients, that is patently not the case.  Many standards of care have never been tested in trials, or worse, have been tested and shown to be wanting in efficacy.  In a recent evaluation of 35 trials of established medical practices, 46% reported results consistent with the current practice, but an additional 46% offered results contradicting current practice, and another 8% were inconclusive.  In other words, more than half of the practices were lacking or had dubious validity.

Among the invalid therapies are vertebroplasty for spinal fractures, demonstrated in two studies to lack effectiveness, but nevertheless now utilized as much or more than before the studies were published.  Another invalidated procedure is the use of coronary artery stents in the treatment of stable angina.  Stents provide no advantage in survival, although they do reduce exertional chest pain, but so do medications, and with much less risk.

The authors indicate four damaging consequences of the failure to cease invalid treatments: 1. patients suffer the risks of therapy with no benefit.  2. invalid practices may continue for years.  3. it leads to undermining of trust in the medical system.  4. it is expensive.

It is ironic that physicians repeatedly lament their patients’ lack of good sense in rejecting drug and surgical therapies in favor of unproven alternative approaches.  Rather, it is often the physicians who lack good sense, who are unscientific, who hold on to unverified tradition because it provides them with professional and financial comfort.

It is of beneficial to look outside the box from time to time, because the box can get old and dark, and occlude vision and judgment.

Allan Sosin

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