'Perverse Incentives' Perpetuate Use of Disproven Medical Treatments
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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