'Perverse Incentives' Perpetuate Use of Disproven Medical Treatments
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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