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In reply II—Reversal of Medical Practices
MAYO CLINIC PROCEEDINGS
legitimately outperforms an older one. The case of chronic myelogenous leukemia is of serial replacement, while stenting for angina constitutes a medical reversal. Vinay Prasad, MD National Cancer Institute Bethesda, MD
Adam Cifu, MD University of Chicago Chicago, IL
1. Prasad V, Vandross A, Toomey C, et al. A decade of reversal: an analysis of 146 contradicted medical practices. Mayo Clin Proc. 2013;88(8):790-798. 2. Boden WE, O’Rourke RA, Teo KK, et al; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-1516. 3. Weinstein KJ. A simple health-care fix fizzles out The Wall Street Journal website. http://online.wsj. com/article/SB1000142405274870365210457465 2401818092212.html. Published February 11, 2010. Accessed August 11, 2013. 4. Tatsioni A, Bonitsis NG, Ioannidis JP. Persistence of contradicted claims in the literature. JAMA. 2007; 298(21):2517-2526. 5. Hall JB. Use of the pulmonary artery catheter in critically ill patients: was invention the mother of necessity [editorial]? JAMA. 2000;283(19):2577-2578. 6. Cortes J, Kantarjian H. How I treat newly diagnosed chronic phase CML. Blood. 2012;120(7):1390-1397. http://dx.doi.org/10.1016/j.mayocp.2013.08.011
In reply IIdReversal of Medical Practices The implementation time frame of reversals, ie, how long does it take for a replaced practice to disappear from clinical use, is a question that
1184
is worthwhile answering with collation of data from multiple reversals. Scattered evidence suggests that the process can be slow and accompanied by resistance from adherents of the refuted practice. Resistance to change may be fueled by financial or professional conflicts of interest. Examples include hormone treatment in postmenopausal women,1-3 vitamins for preventive use,3 and use of percutaneous interventions for stable coronary artery disease that can be well managed with drugs.4 It seems that, unfortunately, historical treatments may not necessarily resurface into use once a newer treatment has been refuted. Among existing network meta-analyses, it is common to miss evidence on important comparisons between the newest treatments and older standards. Distinct treatment epochs are characteristic of the therapeutics of multiple diseases. There are many (mostly unjustified) disincentives in using very old (but potentially still very effective) drugs as standard comparators.5 Moreover, there is some evidence, in fact from oncology trials, that the perceived effectiveness of treatments may be spuriously larger when these treatments are new, as compared with when they are the older regimen tested in a pairwise randomized comparison (the so-called novelty effect, or novelty bias).6 In all, “medical archaeology” may be very relevant, and archaeological treatments may sometimes even be the best that we have to offer.
John P. A. Ioannidis, MD, DSc Stanford University School of Medicine Stanford, CA 1. Fugh-Berman AJ. The haunting of medical journals: how ghostwriting sold “HRT.” PLoS Med. 2010; 7(9):e1000335. 2. Tatsioni A, Siontis GC, Ioannidis JP. Partisan perspectives in the medical literature: a study of high frequency editorialists favoring hormone replacement therapy. J Gen Intern Med. 2010; 25(9):914-919. 3. Tatsioni A, Bonitsis NG, Ioannidis JP. Persistence of contradicted claims in the literature. JAMA. 2007; 298(21):2517-2526. 4. Siontis GC, Tatsioni A, Katritsis DG, Ioannidis JP. Persistent reservations against contradicted percutaneous coronary intervention indications: citation content analysis. Am Heart J. 2009; 157(4):695-701. 5. Lathyris DN, Patsopoulos NA, Salanti G, Ioannidis JP. Industry sponsorship and selection of comparators in randomized clinical trials. Eur J Clin Invest. 2010;40(2):172-182. 6. Salanti G, Dias S, Welton NJ, et al. Evaluating novel agent effects in multiple-treatments meta-regression. Stat Med. 2010;29(23):2369-2383. http://dx.doi.org/10.1016/j.mayocp.2013.08.014
CORRECTION In the Residents’ Clinic, “76-Year-Old Woman With Pruritis and Lip Swelling,” which appeared in the August 2013 issue of Mayo Clinic Proceedings (2013;88(8):e79-e84), “pruritis” should have been spelled “pruritus” throughout the manuscript, including the title. http://dx.doi.org/10.1016/j.mayocp.2013.08.009
Mayo Clin Proc.
n
October 2013;88(10):1180-1184 www.mayoclinicproceedings.org
legitimately outperforms an older one. The case of chronic myelogenous leukemia is of serial replacement, while stenting for angina constitutes a medical reversal. Vinay Prasad, MD National Cancer Institute Bethesda, MD
Adam Cifu, MD University of Chicago Chicago, IL
1. Prasad V, Vandross A, Toomey C, et al. A decade of reversal: an analysis of 146 contradicted medical practices. Mayo Clin Proc. 2013;88(8):790-798. 2. Boden WE, O’Rourke RA, Teo KK, et al; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-1516. 3. Weinstein KJ. A simple health-care fix fizzles out The Wall Street Journal website. http://online.wsj. com/article/SB1000142405274870365210457465 2401818092212.html. Published February 11, 2010. Accessed August 11, 2013. 4. Tatsioni A, Bonitsis NG, Ioannidis JP. Persistence of contradicted claims in the literature. JAMA. 2007; 298(21):2517-2526. 5. Hall JB. Use of the pulmonary artery catheter in critically ill patients: was invention the mother of necessity [editorial]? JAMA. 2000;283(19):2577-2578. 6. Cortes J, Kantarjian H. How I treat newly diagnosed chronic phase CML. Blood. 2012;120(7):1390-1397. http://dx.doi.org/10.1016/j.mayocp.2013.08.011
In reply IIdReversal of Medical Practices The implementation time frame of reversals, ie, how long does it take for a replaced practice to disappear from clinical use, is a question that
1184
is worthwhile answering with collation of data from multiple reversals. Scattered evidence suggests that the process can be slow and accompanied by resistance from adherents of the refuted practice. Resistance to change may be fueled by financial or professional conflicts of interest. Examples include hormone treatment in postmenopausal women,1-3 vitamins for preventive use,3 and use of percutaneous interventions for stable coronary artery disease that can be well managed with drugs.4 It seems that, unfortunately, historical treatments may not necessarily resurface into use once a newer treatment has been refuted. Among existing network meta-analyses, it is common to miss evidence on important comparisons between the newest treatments and older standards. Distinct treatment epochs are characteristic of the therapeutics of multiple diseases. There are many (mostly unjustified) disincentives in using very old (but potentially still very effective) drugs as standard comparators.5 Moreover, there is some evidence, in fact from oncology trials, that the perceived effectiveness of treatments may be spuriously larger when these treatments are new, as compared with when they are the older regimen tested in a pairwise randomized comparison (the so-called novelty effect, or novelty bias).6 In all, “medical archaeology” may be very relevant, and archaeological treatments may sometimes even be the best that we have to offer.
John P. A. Ioannidis, MD, DSc Stanford University School of Medicine Stanford, CA 1. Fugh-Berman AJ. The haunting of medical journals: how ghostwriting sold “HRT.” PLoS Med. 2010; 7(9):e1000335. 2. Tatsioni A, Siontis GC, Ioannidis JP. Partisan perspectives in the medical literature: a study of high frequency editorialists favoring hormone replacement therapy. J Gen Intern Med. 2010; 25(9):914-919. 3. Tatsioni A, Bonitsis NG, Ioannidis JP. Persistence of contradicted claims in the literature. JAMA. 2007; 298(21):2517-2526. 4. Siontis GC, Tatsioni A, Katritsis DG, Ioannidis JP. Persistent reservations against contradicted percutaneous coronary intervention indications: citation content analysis. Am Heart J. 2009; 157(4):695-701. 5. Lathyris DN, Patsopoulos NA, Salanti G, Ioannidis JP. Industry sponsorship and selection of comparators in randomized clinical trials. Eur J Clin Invest. 2010;40(2):172-182. 6. Salanti G, Dias S, Welton NJ, et al. Evaluating novel agent effects in multiple-treatments meta-regression. Stat Med. 2010;29(23):2369-2383. http://dx.doi.org/10.1016/j.mayocp.2013.08.014
CORRECTION In the Residents’ Clinic, “76-Year-Old Woman With Pruritis and Lip Swelling,” which appeared in the August 2013 issue of Mayo Clinic Proceedings (2013;88(8):e79-e84), “pruritis” should have been spelled “pruritus” throughout the manuscript, including the title. http://dx.doi.org/10.1016/j.mayocp.2013.08.009
Mayo Clin Proc.
n
October 2013;88(10):1180-1184 www.mayoclinicproceedings.org