title: A decade of reversal: an analysis of 146 contradicted medical practices.
abstract: OBJECTIVE
  To identify medical practices that offer no net benefits.
  
  
  METHODS
  We reviewed all original articles published in 10 years (2001-2010) in one high-impact journal. Articles were classified on the basis of whether they addressed a medical practice, whether they tested a new or existing therapy, and whether results were positive or negative. Articles were then classified as 1 of 4 types: replacement, when a new practice surpasses standard of care; back to the drawing board, when a new practice is no better than current practice; reaffirmation, when an existing practice is found to be better than a lesser standard; and reversal, when an existing practice is found to be no better than a lesser therapy. This study was conducted from August 1, 2011, through October 31, 2012.
  
  
  RESULTS
  We reviewed 2044 original articles, 1344 of which concerned a medical practice. Of these, 981 articles (73.0%) examined a new medical practice, whereas 363 (27.0%) tested an established practice. A total of 947 studies (70.5%) had positive findings, whereas 397 (29.5%) reached a negative conclusion. A total of 756 articles addressing a medical practice constituted replacement, 165 were back to the drawing board, 146 were medical reversals, 138 were reaffirmations, and 139 were inconclusive. Of the 363 articles testing standard of care, 146 (40.2%) reversed that practice, whereas 138 (38.0%) reaffirmed it.
  
  
  CONCLUSIONS
  The reversal of established medical practice is common and occurs across all classes of medical practice. This investigation sheds light on low-value practices and patterns of medical research.
authors.affiliation: National Cancer Institute, National Institutes of Health, Bethesda, MD. Electronic address: vinayak.prasad@nih.gov.
authors.forename: Vinay
authors.initials: V
authors.lastname: Prasad
authors.forename: Andrae
authors.initials: A
authors.lastname: Vandross
authors.forename: Caitlin
authors.initials: C
authors.lastname: Toomey
authors.forename: Michael
authors.initials: M
authors.lastname: Cheung
authors.forename: Jason
authors.initials: J
authors.lastname: Rho
authors.forename: Steven
authors.initials: S
authors.lastname: Quinn
authors.forename: Satish Jacob
authors.initials: SJ
authors.lastname: Chacko
authors.forename: Durga
authors.initials: D
authors.lastname: Borkar
authors.forename: Victor
authors.initials: V
authors.lastname: Gall
authors.forename: Senthil
authors.initials: S
authors.lastname: Selvaraj
authors.forename: Nancy
authors.initials: N
authors.lastname: Ho
authors.forename: Adam
authors.initials: A
authors.lastname: Cifu
mesh_terms: D035843:Biomedical Research / Q000379:methods / Q000592:standards / Q000639:trends; D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D055811:Journal Impact Factor; D017712:Peer Review, Research; D010506:Periodicals as Topic; D011364:Professional Practice / Q000592:standards / Q000639:trends; D012107:Research Design / Q000592:standards; D059039:Standard of Care