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'Perverse Incentives' Perpetuate Use of Disproven Medical Treatments

Cheryl Clark, for HealthLeaders Media, August 6, 2013

He adds, "All of us in our professional lives should inject a little more reflection in what we're doing, and reappraise regularly on whether what we're doing is based on the most solid evidence. That would go a long way."

Prasad's study was conducted with researchers at Yale University, Northwestern University, Lankenau Medical Center in Philadelphia, George Washington University, University of Maryland Medical Center and the University of Chicago.

They reviewed 2,044 articles published between 2001 and 2010, and selected 1,344 that concerned a medical practice. Of these, 981 examined a new medical practice and 363 tested an established practice. Of these 1,344, 947 had positive findings, but 397 were negative findings.

Of these 1,344, 756 suggested a medical practice should replace an older standard of care, 165 found that a new practice failed to surpass an older practice, 146 found that a current medical practice was actually inferior to a prior standard and the remaining 138 reaffirmed the older practice.

"Looking at all the examples we put together, the unifying theme is that the most common reason for things being found not to work is that they were actually adopted based on poor quality evidence," Prasad says.  

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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.