![]() ![]() Many of these 396 reversals had been the subject of systematic reviews: in 209 cases (53%) the systematic review confirmed that the medical practice in question was indeed a medical reversal in 109 cases (28%) the results of the systematic review were inconclusive and for 78 cases (20%) there was no systematic review. Resultsĭownload asset Open asset Flowchart of selection process to identify included randomized trials. It is our hope that, by building on previous efforts in this area ( Prasad et al., 2013), this list will help others to eliminate the use of these practices. Here we report how a systematic search of randomized controlled trials in three leading medical journals – the Journal of the American Medical Association (JAMA), the Lancet, and the New England Journal of Medicine (NEJM) – identified 396 medical reversals. The Choosing Wisely initiative in the US maintains a list of low-value medical practices, but it relies on medical organizations to report such practices and often includes only those practices where there is a high degree of consensus ( Beaudin-Seiler, 2016). For example, Cochrane reviews provide high-quality evidence on medical practices ( Garner et al., 2013), but each review focuses on only one practice and many practices have not been reviewed by Cochrane. It can, however, be difficult to identify medical reversals. Medical reversals are a subset of low-value medical practices and are defined as practices that have been found, through randomized controlled trials, to be no better than a prior or lesser standard of care ( Prasad et al., 2013 Prasad et al., 2011). Identifying and eliminating low-value medical practices will, therefore, reduce costs and improve care. Such practices can result in physical and emotional harm, undermine public trust in medicine, and have both an opportunity cost ( Korenstein et al., 2018) and a financial cost ( Reid et al., 2016 Beaudin-Seiler, 2016). More than 12 hours later, Gedela would arrive and pore over the latest issues of publications such as Talanta: The International Journal of Pure and Applied Analytical Chemistry.Low-value medical practices are medical practices that are either ineffective or that cost more than other options but only offer similar effectiveness ( Prasad et al., 2013 Prasad et al., 2011 Schpero, 2014). The beat-up vehicles lacked air conditioning and bathrooms and jostled over cracked roads baking in 95F heat. To solve his immediate problem, Gedela paid 250 rupees (about $4) each month for an overnight bus to visit research institutions in Hyderabad, about 400 miles away. How were budding scientists like him supposed to advance, he wondered, without the tools afforded to their more privileged counterparts in the West? He was raised there in a mud-walled, sugar-cane-roofed shack by farming parents. Gedela comes from Allena, a village of roughly 2,000 people. As Gedela tells it, he was trying to break new ground on diabetes, and Andhra’s research library was woefully understocked. But subscriptions to the top publications can cost thousands of dollars a year. Since the 17th century, medical journals have been the portal through which researchers gain insight into the latest discoveries and best practices from colleagues continents away. Srinubabu Gedela was 24 in 2006 and studying for his doctorate at Andhra University in Visakhapatnam, on the east coast of India, when he faced firsthand what he’d later view as a scourge plaguing scientists in the developing world. ![]()
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