Like the Leaning Tower of Pisa, the two New England Journal of Medicine papers by disgraced Dutch researcher Don Poldermans will never stand straight. But like the famous Tower they are also unlikely to topple anytime soon. Without attracting a lot of attention, back in August the NEJM editors decided not to retract the papers or publish an expression of concern. But they did add an “Editor’s note” to the articles referring readers to a Dutch investigation into the studies.
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Click here to read the full post on Forbes.
The Leaning tower of Pisa (Photo credit: Wikipedia)
And then you wonder why “Medical Reversal” is so rampant in the NEJM !
From Mayo Proceedings http://www.mayoclinicproceedings.org/article/S0025-6196(13)00405-9/fulltext
A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices
Vinay Prasad, MDemail, Andrae Vandross, MD, Caitlin Toomey, MD, Michael Cheung, MD, Jason Rho, MD, Steven Quinn, MD, Satish Jacob Chacko, MD, Durga Borkar, MD, Victor Gall, MD, Senthil Selvaraj, MD, Nancy Ho, MD, Adam Cifu, MD
Published Online: July 22, 2013
Abstract
Objective
To identify medical practices that offer no net benefits.
Methods
We reviewed all original articles published in 10 years (2001-2010) in one high-impact journal. Articles were classified on the basis of whether they addressed a medical practice, whether they tested a new or existing therapy, and whether results were positive or negative. Articles were then classified as 1 of 4 types: replacement, when a new practice surpasses standard of care; back to the drawing board, when a new practice is no better than current practice; reaffirmation, when an existing practice is found to be better than a lesser standard; and reversal, when an existing practice is found to be no better than a lesser therapy. This study was conducted from August 1, 2011, through October 31, 2012.
Results
We reviewed 2044 original articles, 1344 of which concerned a medical practice. Of these, 981 articles (73.0%) examined a new medical practice, whereas 363 (27.0%) tested an established practice. A total of 947 studies (70.5%) had positive findings, whereas 397 (29.5%) reached a negative conclusion. A total of 756 articles addressing a medical practice constituted replacement, 165 were back to the drawing board, 146 were medical reversals, 138 were reaffirmations, and 139 were inconclusive. Of the 363 articles testing standard of care, 146 (40.2%) reversed that practice, whereas 138 (38.0%) reaffirmed it.
Conclusion
The reversal of established medical practice is common and occurs across all classes of medical practice. This investigation sheds light on low-value practices and patterns of medical research.
There is too much coronation and piety (near religious intensity) now when papers are peer-reviewed and published. As the Mayo Clinic article shows, reversals are common. Greater headline space needs to be given to these reversals/critiques/minority opinions.