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 baseand 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.
About the Author
Vinayak K. Prasad, MD, MPH, is a practicing hematologist-oncologist and internal medicine physician. He is an associate professor of medicine and public health at Oregon Health & Science University. Adam S. Cifu, MD, is a professor of medicine at the University of Chicago. He is a practicing general internist, medical educator, and the coauthor of Symptom to Diagnosis: An Evidence-Based Guide.
Table of Contents
Examples, Frequency, and Consequences
1. What Is Medical Reversal?
2. Subjective Outcomes
Why Feeling Better Is Often Misleading
3. Surrogate Outcomes
4. Screening Tests
5. Systems Failure
6. Finding Flawed Therapies on Our Own
7. The Frequency of Medical Reversal
8. The Harms of Medical Reversal
Today's Patients, Tomorrow's Patients, and the Health-Care Field
9. A Primer on Evidence-Based Medicine
What Is Evidence in Medicine?
10. What Really Made You Better
When Evidence Gets Complicated
11. Scientific Progress, Revolution, and Medical Reversal
12. Sources of Flawed Data
13. Why Are We So Attracted to Flawed Therapies?
14. Medical Education
A Very Good Place to Start
15. Academic Medicine
16. Reforming the System
The Burden of Proof and Nudging Our Way Past Reversal
17. How Not to Become a Victim of Reversal
18. Beyond Dogma
When Randomized Trials Are Unnecessary
What People are Saying About This
"An important book that frames medical reversal in a compelling way. Readers will be drawn to this clearly written account."
"An outstanding, genre-defining work, this book will be read by students, educators, policymakers, scientists, scholars, medical skeptics, and health-care pundits alike."