A new study detects 396 clinical practices that should be reversed

A medical reversal is the need to stop a clinical activity because a well-done study shows that in the real world the desired results are not being met, or that the adverse effects don’t outweigh the benefits. In a previous review (2013) of over 2,000 NEJM articles, Vinay Prasad and his team already discovered 146 clinical practices that should be reversed and, given the significance of the finding, the Catalan Society of Healthcare Management (SCGS) invited Vinay Prasad to explain it to us live, which he did on March 18, 2018 (you can see the video of the conference at the link).

Now, a new, more ambitious review (2019) carried out by the same team, with over 3,000 articles from NEJM, JAMA and The Lancet, has identified 396 clinical activities that should be reversed, for the good of the patients and the good of the economy. The areas most in need of reversion are (see chart): cardiovascular diseases, medicine practised in critically ill patients, secondary prevention programs, cancer treatments, obstetrics and gynaecology, neurology and neurosurgery, orthopaedics, etc., But there is also a need for the reversal in practices considered alternatives, such as certain behavioural therapies, mindfulness interventions, acupuncture, omega-3 or vitamin A dietary supplements, some community health programs, and introducing certain wearables.

Two conclusions from Vinay Prasad's team reviews

The first conclusion is that it’s necessary for governments and regulatory agencies to be more rigorous, and to be seriously involved in the methodologies that the industry presents to them to approve the efficacy and clinical effectiveness of all innovations, be new diagnostic devices, new surgical techniques or new medications. Please note that once a clinical practice has become popular, reversal is very difficult and also has a budget cut flavour.

The second conclusion is that governments and their agencies should further promote and finance independent evaluations of consolidated clinical practices, in order to confirm their clinical effectiveness and value perceived by patients.

In the two previous conclusions, between 25% and 40% of the budgets of all the health systems in the world are at stake, a waste that should be addressed if health is more valuable and more adjusted to the genuine needs of people.

Jordi Varela
Editor