DISPROVEN, NOT DISCARDED

I was recently looking for some statistics on iatrogenesis. That's just a fancy term for the medical system screwing up and causing harm rather than preventing or relieving it. Think: hospital acquired infections, adverse drug reactions, medical errors, psychological damage, and the like. However, as so often happens, I couldn't find what I was looking for but accidentally stumbled upon this extremely interesting study on the prevalence of ineffective medical treatments and practices.

I'd never given much thought to how common ineffective or low-value treatments are or to the ills resulting from them. Medical interventions demonstrated to be ineffective or just arbitrarily costing more than alternatives of equivalent effectiveness aren’t just merely bad. Low-value practices and treatments are shown to result in a spectrum of harms and yield detrimental opportunity and financial costs, all while undermining the public's faith in medicine. (See: Beaudin-Seiler, 2016; Korenstein et al, 2018; Prasad et al, 2013; Schpero, 2014.) It’s a real problem.

This systematic review looked at 15 years worth of studies (covering more than 3,000 articles) published in leading medical journals: The Lancet, the Journal of the American Medical Association, and The New England Journal of Medicine. Found within all fields of medicine, these researchers uncovered a total of 396 ineffective medical practices, procedures, therapies, medications, dietary supplements, medical devices, tests, and screenings, all of which were demonstrated ineffective, or worse, through randomized controlled trials. Troublingly, you can find these disproven medical offerings being promoted and delivered to patients all around the world.

So, here are some examples of low-value aids, treatments, screenings, procedures, and hospital protocols impacting loads of people:

• Wearable devices for tracking physical activity have become super popular as a weight-loss aid. But this has been studied and the results are contrary to what you might assume. Several investigations have resulted in similar findings, specifically that "weight loss was significantly less among the group that had access to wearable technology compared to the group that did not."

• Several studies have looked at outcomes for people receiving ether surgery or physical therapy for knee osteoarthritis and meniscal tear. Surgery is performed on almost 500,000 people in the US annually despite randomized controlled trials continually showing no difference in pain relief or functional improvement over 24 months between arthroscopic surgery and non-operative groups.

• Hormone replacement therapy has been offered to improve health and reduce chronic illness, cancers, stroke, and cardiac death in postmenopausal women since the 1940s. Many randomized trials have continually shown no such value.

• Despite regular promotion, many studies have shown nicotine patches (nicotine replacement therapy, aka NRT) for smoking cessation in pregnant women to be no better than placebo. Worse than that, a Cohrane review showed "There is insufficient evidence to determine whether or not NRT is effective or safe when used to promote smoking cessation in pregnancy or to determine whether or not using NRT has positive or negative impacts on birth outcomes."

• Breast screenings are commonly recommended for women over age 40. The evidence shows that, at best, there's a small benefit to screenings while offering women significant risk of serious harms from false positives and overdiagnosis. The best data we have shows that, for every 2,000 women screened for breast cancer, one will avoid dying from breast cancer while 10 healthy women will be unnecessarily treated and more than 200 will experience significant detrimental effects from false positive results. Importantly, systematic review of the literature found that more recent observational studies show still greater incidence of overdiagnosis and very little to no reduction in advanced cancers.

• To reduce the risk of hip fractures, various forms of hip protectors are often prescribed for folks over age 70. Review of 19 studies looking into the effectiveness shows that though "hip protectors probably reduce the risk of hip fractures slightly", but only in care home settings and not at home, while also slightly increasing the likelihood of pelvic fractures.

• With the spread of antibiotic resistant bacteria in healthcare settings, "contact protections" (gloves and gowns) were recommended by the CDC. Randomized studies looking at intensive care units, comparing units with regular protocols to ones with mandatory universal contact protections, showed "no difference in the acquisition of methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus between ICUs..."