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'Perverse Incentives' Perpetuate Use of Disproven Medical Treatments

Cheryl Clark, for HealthLeaders Media, August 6, 2013

In what researchers are calling "the largest and most comprehensive study of medical (finding) reversal," they identify 146 medical practices that have been refuted by subsequent studies, but which continue to be used by providers.

Flawed research too often prompts doctors and hospitals to rush in technologies or practices which subsequent studies resoundingly refute. Yet despite solid contradicting evidence, some doctors take years to change their recommended care, and others just don't.

That's the conclusion of researchers who looked at 146 medical practices based on studies published in the New England Journal of Medicine, whose conclusions were reversed by subsequent scientific trials within the next 10 years. The new paper is published in the August issue of the Mayo Clinic Proceedings, and authors wrote that it is "the largest and most comprehensive study of medical (finding) reversal."


See Also: Berwick: Zapping Overtreatment, Costs Takes 'Courage'


"What we found is that when we learn in certain cases that we were wrong, it's much harder to stop doing something that we have been doing, especially when there's money involved, and especially when the finances of the person making the recommendation are tied to the patient going through [with the recommended care]," says Vinay Prasad, MD, an oncologist with the National Cancer Institute and lead author of the report.

"It's a perverse incentive, that's what Don Berwick talks about, and that's what we're identifying."

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1 comments on "'Perverse Incentives' Perpetuate Use of Disproven Medical Treatments"


Jeff angel, M D (8/7/2013 at 2:53 PM)
Cheryl, The article is timely. It overstates some obvious flaws in our medical system. But to take those instances( which a lot are dated)[INVALID]yes, most have quit doing a lot of those practices and say the whole system is better if we do less is oversimplification to the point of intellectual disingenuity. And on top of that, to infer that docs/surgeons dont pay attention to guidelines, changes is absurd. As an orthpaedic surgeon, I spend about 2 hours of my thoughts per week on checking protocols and patient care decision processes.Many hours are spent adjusting treatment regimens including not doing acromioplasties automatically with rotatorcuff repairs, not doing knee scopes on patients with macerated meniscii and worn out knees, not doing a TKA until patient had stepped mgmt including tylenol, nsaid, injections, wt loss, aerobic activity, cane; and also runnjng an osteoporosis clinic with my PA to treat patients for osteoporosis for fragility fractures and put them on agents . Very offensive approach to tell docs we do everything wrong!!!! Most of what we do is right and we do respond!!! Your study is an over generalization of a very complex problem[INVALID][INVALID]-what defines a good study and what constitutes changing practice standards. Shane on those who say terms like perverse and we should do less...in some cases yes, but to damn the system is ignorant or dishonest.