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'Perverse Incentives' Perpetuate Use of Disproven Medical Treatments

Cheryl Clark, for HealthLeaders Media, August 6, 2013

In one of dozens of examples, the article explains that research attempting to test whether bispectral index (BIS) monitors, designed to calculate whether anesthesia administered to patients undergoing procedures in which they needed to be asleep, was sufficient to eliminate their awareness.

The device received U.S. Food and Drug Administration approval in 1997 based on two trials, one an industry-sponsored study that did not use standard protocols for comparison and the other which wasn't large enough to draw conclusions.

"Nevertheless the monitors' use increased. By July 2007, half of all operating rooms in the United States had a BIS monitor," gaining acceptance "largely through vocal support from prominent advocates and faith that the mechanism of action is sound."

In 2008, a large randomized trial compared the BIS with standard sedation monitoring and "found no benefit for the device on anesthesia awareness."

In an interview, Prasad says that because all too often, poorly designed research studies are reversed, doctors question what care practice evidence they should value and what they should take with a grain of salt.

"Because of these reversals, there's a frustration, that you can't trust a recommendation."

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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.