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Medical procedures may change but are they better?

Most of us assume that if a doctor adopts new medical procedures or drug it should be better than those which are discarded. Not so. Scientists who recently reviewed each issue of The New England Journal of Medicine from 2001 through 2010 found 363 studies examining established clinical practice. What the scientists found is that often the new drugs or procedures which have replaced the old ones are no better and no more effective, but many doctors persist in using them even if they have been shown to be useless or even harmful.


Which medical procedures have been found to be ineffective or harmful?


According to the scientists, “40 percent of established practices studied were found to be ineffective or harmful, 38 percent beneficial, and the remaining 22 percent unknown.” Some of the most ineffective were high-dose chemotherapy and stem cell transplant, which have been found to be no better than traditional chemotherapy treatments and hormone therapy in postmenopausal women. Other doctors refused to give certain types of medical procedures which could be helpful. For instance, “women with lupus were denied oral contraceptives for fear they increased the severity of the disease, and epidural anesthesia was delayed during childbirth on the theory it increased the rate of Caesarean sections.” These medical procedures continue to be denied even though there is no evidence they are harmful.

What do the doctors say about new medical procedures?


Many doctors appreciated the study about medical procedures concluding that old habits die hard. Some experts suggest it could take time to change doctor’s minds and attitudes about medical procedures. Others conclude that it is time for doctors to evaluate some of their attitudes and make sure there is evidence to support the use of specific medical procedures. This could become even more critical with major health care changes which will require doctors to ensure the money they are given is being well utilized.

Doctors saved their harshest criticism for new medical devices. For instance, Dr. Prasad, chief fellow in medical oncology at the National Cancer Institute, noted that new medical appliances are introduced all the time. He works closely with catheters and stated, “We continue to introduce new catheters all the time, lacking good evidence that they work. This is a tremendous waste of resources.”

What questions need to be asked about new medical procedures?


Doctors agree that new questions need to be asked. It’s important to analyze what medical procedures are supposed to do and understand how they work, but this doesn’t get to the better question of whether or not they successfully treat a specific condition. Before a new drug is used or a new medical procedure is implemented the better question is, “What evidence is there that it does what you say it does?”

Patients will also have to be more proactive in their own medical care. With the cost of medical care skyrocketing all of us need to ask not only about cost but whether or not a new, exciting and more costly procedure is really necessary or whether something else that has been on the market for years can do the trick just fine.
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