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Why medicine adopts ineffective or harmful medical practices only to abandon them—sometimes too late.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.

Table of Contents

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  1. Cover
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  1. Title Page, Copyright, Dedication
  2. pp. i-vi
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  1. Contents
  2. pp. vii-x
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  1. Introduction
  2. pp. 1-8
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  1. Part I. Medical Reversal: Examples, Frequency, and Consequences
  1. 1. What Is Medical Reversal?
  2. pp. 11-19
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  1. 2. Subjective Outcome: Why Feeling Better Is Often Misleading
  2. pp. 20-29
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  1. 3. Surrogate Outcomes
  2. pp. 30-42
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  1. 4. Screening Tests
  2. pp. 43-56
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  1. 5. Systes Failure
  2. pp. 57-68
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  1. 6. Finding Flawed Therapies on Our Own
  2. pp. 69-80
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  1. 7. The Frequency of Medical Reversal
  2. pp. 81-87
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  1. 8. The Harms of Medical Reversal: Today’s Patients, Tomorrow’s Patients, and the Health-Care Field
  2. pp. 88-96
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  1. Part II: An Interlude on Evidence
  1. 9. A Primer on Evidence-Based Medicine: What Is Evidence in Medicine?
  2. pp. 99-108
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  1. 10. What Really Made You Better: When Evidence Gets Complicated
  2. pp. 109-122
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  1. Part III: The Origins of Reversal
  1. 11. Scientific Progress, Revolution, and Medical Reversal
  2. pp. 125-134
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  1. 12. Sources of Flawed Data
  2. pp. 135-147
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  1. 13. Why Are We so Attracted to Flawed Therapies?
  2. pp. 148-158
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  1. Part IV: Beyond Reversal
  1. 14. Medical Education: A Very Good Place to Start
  2. pp. 161-172
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  1. 15. Academic Medicine
  2. pp. 173-182
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  1. 16. Reforming the System: The Burden of Proof and Nudging Our Way Past Reversal
  2. pp. 183-194
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  1. 17. How Not to Become a Victim of Reversal
  2. pp. 195-204
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  1. 18. Beyond Dogma: When Randomized Trials Are Unnecessary
  2. pp. 205-214
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  1. Acknowledgments
  2. pp. 215-216
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  1. Appendix
  2. pp. 217-246
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  1. References
  2. pp. 247-256
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  1. Index
  2. pp. 257-265
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