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Full Description
We expect medicine to progress in an orderly fashion, with good medical practices being replaced by better ones. But some tests and therapies are discontinued because they are found to be worse, or at least no better, than what they replaced. Medications like Vioxx and procedures such as vertebroplasty for back pain caused by compression fractures are among the medical "advances" that turned out to be dangerous or useless. What Dr Vinayak K Prasad and Dr Adam S Cifu call medical reversal happens when doctors start using a medication, procedure, or diagnostic tool without a robust evidence base-and then stop using it when it is found not to help, or even to harm, patients. Drs Prasad and Cifu narrate fascinating stories from every corner of medicine to explore why medical reversals occur, how they are harmful, and what can be done to avoid them. They explore the difference between medical innovations that improve care and those that only appear to be promising.
They also outline a comprehensive plan to reform medical education, research funding and protocols, and the process for approving new drugs that will ensure that more of what gets done in doctors' offices and hospitals is truly effective.
Contents
Introduction
Part I
Examples, Frequency, and Consequences
1. What Is Medical Reversal?
2. Subjective Outcomes
Why Feeling Better Is Often Misleading
3. Surrogate Outcomes
4. Screening Tests
5. Systems Failure
6. Finding Flawed Therapies on Our Own
7. The Frequency of Medical Reversal
8. The Harms of Medical Reversal
Today's Patients, Tomorrow's Patients, and the Health-Care Field
Part II
9. A Primer on Evidence-Based Medicine
What Is Evidence in Medicine?
10. What Really Made You Better
When Evidence Gets Complicated
Part III
11. Scientific Progress, Revolution, and Medical Reversal
12. Sources of Flawed Data
13. Why Are We So Attracted to Flawed Therapies?
Part IV
14. Medical Education
A Very Good Place to Start
15. Academic Medicine
16. Reforming the System
The Burden of Proof and Nudging Our Way Past Reversal
17. How Not to Become a Victim of Reversal
18. Beyond Dogma
When Randomized Trials Are Unnecessary
Acknowledgments
Appendix
References
Index
