Ending Medical Reversal: Improving Outcomes, Saving Lives

by Vinayak K. Prasad, Adam S. Cifu

Overview

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.

Product Details

ISBN-13:	9781421417738
Publisher:	Johns Hopkins University Press
Publication date:	11/01/2015
Series:	A Johns Hopkins Press Health Book
Sold by:	Barnes & Noble
Format:	eBook
Pages:	280
File size:	3 MB
Age Range:	18 Years

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.

Vinayak K. Prasad, MD, MPH is a practicing hematologist-oncologist and internal medicine physician. An associate professor of medicine and public health at Oregon Health & Science University, he is the coauthor of Ending Medical Reversal: Improving Outcomes, Saving Lives.

Table of Contents

Introduction
Part I
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
Part II
9. A Primer on Evidence-Based Medicine
What Is Evidence in Medicine?
10. What Really Made You Better
When Evidence Gets Complicated
Part III
11. Scientific Progress, Revolution, and Medical Reversal
12. Sources of Flawed Data
13. Why Are We So Attracted to Flawed Therapies?
Part IV
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
Acknowledgments
Appendix
References
Index

What People are Saying About This

David S. Jones

An important book that frames medical reversal in a compelling way. Readers will be drawn to this clearly written account.

John Henning Schumann

An outstanding, genre-defining work, this book will be read by students, educators, policymakers, scientists, scholars, medical skeptics, and health-care pundits alike.

From the Publisher

An outstanding, genre-defining work, this book will be read by students, educators, policymakers, scientists, scholars, medical skeptics, and health-care pundits alike.
—John Henning Schumann, MD, host of Public Radio Tulsa's Medical Matters

An important book that frames medical reversal in a compelling way. Readers will be drawn to this clearly written account.
—David S. Jones, MD, Harvard University, author of Broken Hearts: The Tangled History of Cardiac Care

Editorial Reviews

Reviewer: Jessica Ruth Ferraro, MHA (James A. Haley Veterans' Hospital)
Description: This book describes medical innovations that in the end have proven, at best, to be equal to current treatment options and, at worst, to have negative consequences for patients. The authors explore several examples of such medical innovations and determine ways to avoid medical reversals.
Purpose: The purpose is to help readers understand how medical reversals occur and what can be done to avoid them, while also proposing solutions for avoiding medical reversals in the future. This book is needed, not only for medical professionals, but also for the general public.
Audience: The introduction notes that this book is written for "people, like us," which I took to mean the authors' fellow practitioners. The book will be helpful to this audience, but I would encourage others to read it as well. The information is not too technical that those in the general healthcare field couldn't understand it.
Features: The introduction describing how evidence-based medicine was a catalyst in highlighting medical reversals really sets the stage for the book. The authors provide insights into how medical reversals in several areas of medicine occurred. Toward the end, they describe a proposed solution for avoiding medical reversals, which I appreciated.
Assessment: This is a wonderful book that truly opens readers' eyes to medical innovations and evidence-based medicine. The quality of the information is outstanding, as is its usefulness. This is a great read for anyone in the field of medicine.

Doody's Review Service

Ending Medical Reversal presents persuasive evidence that many current standard-of-care treatments are probably ineffective or harmful, thoroughly explains how such treatments came to be accepted, and proposes a number of ways to address the general problem (only some of which involve avaricious companies and mercenary physicians) and minimize its impact on a specific patient.
--Journal of Clinical Research Best Practices

Ending Medical Reversal goes far in teaching medical students and practicing physicians alike how to learn on our own.
--The Lancet

[A]n excellent and realistic discussion of some of the horror stories that occur in medical practice . . . The examples are quite interesting and certainly educational for all readers. Highly recommended.
--Choice

Dr. Prasad and Dr. Cifu offer a five-step plan, including pointers for determining if a given treatment is really able to do what you want it to do, and advice on finding a like-minded doctor who won't object to a certain amount of back-seat driving.
--The New York Times

Every doctor should read this book.
--JAMA Internal Medicine

Should be considered for undergraduate reading lists. Keep a copy in the pharmacy or your briefcase as a great icebreaker or discussion point with other local healthcare professionals.
--The Pharmaceutical Journal

This has to be on the reading list for medical and nursing students.
--Nursing Times

When I describe Ending Medical Reversal as revolutionary, I don't use the term lightly. Go out and read it--right now.
--Common Sense Family Doctor

From the Publisher

Every doctor should read this book.

JAMA Internal Medicine

Dr. Prasad and Dr. Cifu offer a five-step plan, including pointers for determining if a given treatment is really able to do what you want it to do, and advice on finding a like-minded doctor who won't object to a certain amount of back-seat driving.

The New York Times

Ending Medical Reversal goes far in teaching medical students and practicing physicians alike how to learn on our own.

The Lancet

This has to be on the reading list for medical and nursing students.

Nursing Times

When I describe Ending Medical Reversal as revolutionary, I don't use the term lightly. Go out and read it—right now.

Common Sense Family Doctor

Should be considered for undergraduate reading lists. Keep a copy in the pharmacy or your briefcase as a great icebreaker or discussion point with other local healthcare professionals.

The Pharmaceutical Journal

[A]n excellent and realistic discussion of some of the horror stories that occur in medical practice . . . The examples are quite interesting and certainly educational for all readers. Highly recommended.

Choice

Ending Medical Reversal presents persuasive evidence that many current standard-of-care treatments are probably ineffective or harmful, thoroughly explains how such treatments came to be accepted, and proposes a number of ways to address the general problem (only some of which involve avaricious companies and mercenary physicians) and minimize its impact on a specific patient.

Journal of Clinical Research Best Practices

"Dr. Prasad and Dr. Cifu offer a five-step plan, including pointers for determining if a given treatment is really able to do what you want it to do, and advice on finding a like-minded doctor who won't object to a certain amount of back-seat driving."

The New York Times

"When I describe Ending Medical Reversalas revolutionary, I don't use the term lightly. Go out and read it—right now."

Common Sense Family Dr.

"Dr. Prasad and Dr. Cifu offer a five-step plan, including pointers for determining if a given treatment is really able to do what you want it to do, and advice on finding a like-minded doctor who won’t object to a certain amount of back-seat driving. Of course, there are no guarantees that their tips will endure forever, but they probably have a longer shelf life than most medical advice."

New York Times

"Campus Sexual Assault: College Women Respond is a concise and coherent book on identity and identity management, following their reported sexual assaults at their places of study"

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