Brook Cheng

July 18, 2025

A 2019 study (Herrera-Perez D. et al, 2019) .explored what does and does not work in the field of modern medical practice, and came up with 396 reported reversals of previously accepted medical practice over the last 15 years.

To do this, Herrera-Perez and her team conducted a search of RCTs published over 15 years in three leading general medical journals: the Journal of the American Medical Association, the Lancet and the New England Journal of Medicine.

A medical reversal refers to a low-value medical practice, which is found to either be ineffective or more costly than an earlier or lower standard of care without offering more benefit.

A full 13% all published RCTs were medical reversals. The greatest number of reversals (20%) related to cardiovascular disease, followed by 12% in public health and 11% in critical care. In one third, a medication was found ineffective, while 20% dealt with ineffective procedures, and 13% with a vitamin or supplement. Only 1% related to over-the-counter medication use.

Some example of the reversals include:

• The immediate delivery of babies following preterm prelabor rupture of the membranes after 34 weeks of pregnancy but before 37 weeks are complete, to reduce newborn sepsis.

• The universal use of protective gowns and gloves to reduce the spread of methicillin-resistant Staphylococcus aureus (MRSA) in ICUs;

• Mammography every 1-2 years after the age of 40 (not recommended until 50 years);

• The use of compression stockings to prevent clots in the leg veins after surgery;

• Wearable technology for weight loss;

• Hormone replacement therapy for menopausal women’s health;

• Cognitive behavioral therapy,

• Supplementation with omega-3 fatty acids;

• Wearable technology used by exercisers who want to lose weight ...

The 396 reversals spans all medical disciplines, adding to 146 already reported reversals. Some of these practices are extremely costly though ineffective. For instance, the drug bevacizumab which received US FDA approval for the treatment of metastatic breast cancer cost $88,000 per year, but its approval was withdrawn just three years later because of the lack of improvement in overall survival.

Once a practice has come into vogue, even for short periods, it is difficult to persuade both patients and medical professionals to abandon it. One way to reduce the number of medical reversals is to insist on having proof of effectiveness in the form of RCTs before the widespread adoption of either novel or older practices. This should be possible for most practices.

References

Liji Thomas, New study finds almost 400 established medical practices that don’t work, News medical. Net. 2019

Herrera-Perez D. et al.,. ...A comprehensive review of randomized clinical trials ... reveals 396 medical reversals. eLife. 2019

#modernmedicine #useless #wasteful #stupidity #criticalthinking