Ending Medical Reversal - Improving Outcomes, Saving Lives

Description

Medications such as Vioxx and procedures such as vertebroplasty for back pain are among the medical "advances" that turned out to be dangerous or useless. What Dr. Vinayak K. Prasad and Dr. Adam S. Cifu call medical reversal happens when doctors start using a medication, procedure, or diagnostic tool without a robust evidence base—and then stop using it when it is found not to help, or even to harm, patients. In Ending Medical Reversal, Drs. Prasad and Cifu narrate fascinating stories from every corner of medicine to explore why medical reversals occur, how they are harmful, and what can be done to avoid them. They explore the difference between medical innovations that improve care and those that only appear to be promising. They also outline a comprehensive plan to reform medical education, research funding and protocols, and the process for approving new drugs that will ensure that more of what gets done in doctors' offices and hospitals is truly effective. COVER......Page 1 CONTENTS......Page 8 INTRODUCTION......Page 12 PART I: MEDICAL REVERSAL: Examples, Frequency, and Consequences......Page 20 1 WHAT IS MEDICAL REVERSAL?......Page 22 2 SUBJECTIVE OUTCOME: Why Feeling Better Is Often Misleading......Page 31 3 SURROGATE OUTCOMES......Page 41 4 SCREENING TESTS......Page 54 5 SYSTEMS FAILURE......Page 68 6 FINDING FLAWED THERAPIES ON OUR OWN......Page 80 7 THE FREQUENCY OF MEDICAL REVERSAL......Page 92 8 THE HARMS OF MEDICAL REVERSAL: Today’s Patients, Tomorrow’s Patients, and the Health-Care Field......Page 99 PART II: AN INTERLUDE ON EVIDENCE......Page 108 9 A PRIMER ON EVIDENCE-BASED MEDICINE: What Is Evidence in Medicine?......Page 110 10 WHAT REALLY MADE YOU BETTER: When Evidence Gets Complicated......Page 120 PART III: THE ORIGINS OF REVERSAL......Page 134 11 SCIENTIFIC PROGRESS, REVOLUTION, AND MEDICAL REVERSAL......Page 136 12 SOURCES OF FLAWED DATA......Page 146 13 WHY ARE WE SO ATTRACTED TO FLAWED THERAPIES?......Page 159 PART IV: BEYOND REVERSAL......Page 170 14 MEDICAL EDUCATION: A Very Good Place to Start......Page 172 15 ACADEMIC MEDICINE......Page 184 16 REFORMING THE SYSTEM: The Burden of Proof and Nudging Our Way Past Reversal......Page 194 17 HOW NOT TO BECOME A VICTIM OF REVERSAL......Page 206 18 BEYOND DOGMA: When Randomized Trials Are Unnecessary......Page 216 ACKNOWLEDGMENTS......Page 226 APPENDIX......Page 228 REFERENCES......Page 258 INDEX......Page 268