Medical Debates and Medical Reversal

Excerpt

Medical reversal occurs when an accepted practice—a diagnostic test, medication, or procedure—is overturned. The practice is not replaced by something better, but shown to be inferior to a preexisting, less intensive, or less invasive one. Sometimes the practice that is overturned is shown to be inferior to no intervention. Every physician is aware of emblematic cases of reversal, such as the use of hormone therapy in post-menopausal women. Medical reversal is common; well over 100 studies have been published in major medical journals over the last 10 years that provide strong evidence that an accepted medical practice was ineffective or harmful.1,2 The debates that follow these publications—whether the reversal concerns a screening test, surgical procedure, medical therapy, or systems intervention—are among the most contentious in medicine. These arguments are important ones; they ultimately decide how we, as a profession, progress in our effort to provide high-value care, and they articulate how we view the standards of evidence upon which we base our practice. The debates that follow reversals adhere to a predictable script, pitting minimalists against maximalists. These debates also place the practicing physician, who must decide what to actually recommend to patients, in a difficult position. …