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'Perverse Incentives' Perpetuate Use of Disproven Medical Treatments

Cheryl Clark, for HealthLeaders Media, August 6, 2013

Among some of the examples listed:

  • Concerns that vaccinations precipitate flare of multiple sclerosis prompt many doctors to omit this intervention, concerns "largely undermined" by two studies in 2001.
  • Worries that oral contraceptives increase lupus flares made doctors reluctant to prescribe them, resulting in a higher rate of unwanted pregnancies and elective abortions among patients with lupus, despite two trials that exonerated the drug as a cause of lupus flares.
  • Despite evidence from numerous studies that the benefit of vertebroplasty, a procedure in which doctors inject a kind of cement into the vertebrae, "was contraindicated by two paired articles," the "referrals actually went up after those studies, Prasad says.

"When you're doing something that, psychologically, it's plausible that it could help, and you're getting reimbursed well, together that's really a strong psychological motivation to doing it," despite what the evidence says.

In an accompanying editorial, John Ioannides, MD, of the Stanford Prevention Research Center, called the NCI article impressive and said that "at a minimum, it poses major questions about the validity and clinical utility of a sizeable portion of everyday medical care."

And, he added, Prasad and colleagues "offer some hints about how this dreadful scenario might be aborted. The 146 medical reversals that they have assembled are, in a sense, examples of success stories that can inspire the astute clinician and clinical investigator to challenge the status quo and realize that doing less is more."


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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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.