Ending Medical Reversal
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albuterol, 25
alcohol dependence, 220
allergens, 223
alternative treatments, 198–99
Alzheimer’s disease, 92, 230
American College of Cardiology, 141
American Heart Association, 141
amnioinfusion, 86, 228
amyloidosis, 234
anagrelide, 227
anemia, 231
anesthesia: awareness during, 236
spinal, cesarean delivery and, 95, 226
aneurysms: abdominal aortic, 86, 220, 244
intracranial, 209, 226
anginal chest pain, 14–15, 27–29, 130
coronary stents for stable angina, 3–4, 6, 11, 15, 20, 27–28, 29, 92, 130, 131, 156, 187, 217, 224, 227, 231, 232
internal mammary artery ligation for, 28–29
angiotensin-converting enzyme inhibitors, 154, 225
anomalies, 128–33, 135
antacids, 82, 129
anterior cruciate ligament (ACL) reconstruction, 23–24, 244
antibiotics, 11, 114, 171, 207
for appendicitis, 111–12
for asymptomatic bacteriuria, 221
bacterial resistance to, 58, 61
for Lyme disease, 219
for peptic ulcer disease, 129
for pneumonia, 65, 191
anticoagulation, 207, 219, 227, 243
anticonvulsants, 219, 239, 245
antidepressants, 232
antipsychotics, 229, 230
aortic regurgitation, 228
appendectomy, 14, 111–12
aprotinin, 229, 236, 237
arsenic therapy, 6, 11, 188
arterial stenosis, intracranial, 227
artery stents, intracranial, 89–91
arthroscopic knee surgery, 22–23, 24, 28, 86, 221, 238
aspirin, 14, 88, 89, 106, 226, 227, 243
asthma, 25, 29, 223, 232, 239
atenolol, 13, 20, 32, 36, 100
atherosclerosis, 86, 91, 131, 223, 224, 241
atorvastatin, 6, 14, 89, 100, 145
atrial fibrillation, 89, 221, 237, 242
Avastin. See bevacizumab
Bell’s palsy, 234
Benefits of Universal Glove and Gown (BUGG) study, 59
benign prostatic hyperplasia (BPH), 43, 229
Bero, Lisa, 144
beta-blockers, 13, 14
beta-carotene, 1, 92
bevacizumab (Avastin), 36–38, 145, 185, 201
birth, preterm, 219, 220, 223
blood sugar control, 30, 32, 38, 197, 237, 238
hemoglobin A1c and, 30–34, 36, 41, 197, 232
in ICU, 61, 67–68, 238
blood thinners, 15, 89, 245
bone health, estrogen and, 2, 3
Breakthrough Therapy Designation, 189, 189f
breast cancer, 1–2, 127, 222, 225
bevacizumab for, 36–38, 145, 185, 201
hormone replacement therapy and, 2, 3, 104
lymphedema after surgery for, 181, 240
mammography screening for, 11, 16–18, 20, 46, 47–48, 50, 51, 52–54, 55, 93–94, 232
mastectomy for, 46, 221
Brett, Allan, 179
bronchiolitis, 223, 233
burden of proof, 162, 183–89, 206
arguments for, 187–88
behavioral changes for adoption of, 188–89
for efficacy of medical devices, 185–86
for malpractice claims, 184–85
medical care in era of, 193
caffeine and miscarriage, 107
calcium supplementation, 71, 72, 73–74, 230
Calderon, Jose, 119
cancer screening tests, 46–48
overdiagnosis due to, 49–51
population data for, 51–54. See also under specific cancers
carcinoid heart disease, 222
Cardiac Arrhythmia Suppression Trial (CAST), 12, 166, 193
cardiac output, 39–40
cardiac stress test, 14, 212
cardiogenic shock, 39–40
cardiopulmonary resuscitation, 244
carotid artery ultrasound, 211
carvedilol, 14n
case-control studies, 106–8
catheters, central venous, 230
cause and effect, 107, 109–10, 114, 121
celecoxib, 227
Centers for Medicare and Medicaid Services, 213
cervical cancer screening, 46, 47, 48, 55
cesarean delivery, 95, 226
cetuximab, 114
chiropractic, 69
cholesterol level, 32, 34–36, 89
cholesterol-lowering drugs, 11, 14, 34–36, 85, 89, 101, 141, 165–66, 236, 242
after heart attack, 6, 36, 199. See also statins; specific drugs
cholestyramine, 6
chondroitin sulfate, 72, 230
clinical decision rules, 212
clinical trials, 2
appraisal of, 5
industry-sponsored, 136–40, 176–77
naming of, 12n; selective reporting of, 139. See also randomized controlled trials
clopidogrel, 15, 226, 245
Cobb, Leonard, 29
cognitive dissonance, 77–78
cohort trials, 103–6
colorectal cancer, 114, 227, 245
colonoscopy screening for, 46, 47, 48, 49, 199, 243
complementary treatments, 69–70
lack of regulation of, 77
placebo effect for, 26
reasons for use of, 75–78
reversals for, 74–75, 77
conflicts of interest in practice guidelines, 140–42, 147
confounding variables, 105
consumers, health-care, 151
continuous positive airway pressure, 229
contraception, 229
Copernicus, 128
coronary angiogram, 14–15, 28
coronary-artery bypass grafting, 227, 236, 240
coronary-artery revascularization, 225
coronary heart disease, 14, 224
coronary stents: drug-eluting, 231
for stable angina, 3–4, 6, 11, 15, 20, 27–28, 29, 92, 130, 131, 156, 187, 217, 224, 227, 231, 232
corticosteroids, 223, 230, 233–36
COURAGE trial, 27–28, 29, 92, 130, 131, 133, 156, 217, 232
C-reactive protein, 224
critically ill patients, 83, 155, 206, 230, 238, 241, 242
CT-scan screening for lung cancer, 46, 47, 48–49, 54–55
cystic fibrosis, 235
darbepoietin alfa, 241
depression, 152, 156, 176, 245
bipolar, 232
postpartum, 99, 100
dexamethasone, 223, 233, 234, 235
DHEA, 231
Dhruva, Sankeet, 144
diabetes mellitus, 221, 241, 242, 243
gestational, 237
hemoglobin A1c in, 30–34, 36, 41, 197, 232
diagnostic tests, 209–12. See also screening tests
dialysis patients, 85, 209, 239, 245
diet, 1, 31, 71, 78–80, 149, 180–81, 220
Mediterranean, 78–79
dietary supplements, 69–70
diethylstilbestrol, 94
digoxin, 221
dipyridamole, 89
dire and rare situations, 206–8
direct-to-consumer (DTC) advertising, 152–53
discovery and replication, 177–78
burden of proof for, 183–89
stages in career of medical innovation, 4–5, 133–34
distrust of medical system, 18, 93–94, 95
doctor-patient relationship, 19, 195, 196, 202–3
medical education about, 167, 168
patient scheduling and, 196
placebo effect and, 25
using doctor’s experience and expertise, 202–3
and what makes a good doctor, 163–64
and white-coat silence, 196
dopamine, 242
drug testin
g in developing countries, 188
echinacea, 71, 72, 76, 228
empathy, 8, 164
emphysema, 40, 181
empiricism vs. reductionism, 154–55, 165
end points, 162, 197–99
of diagnostic tests, 211
studies showing treatment-related improvement of, 198–99
subjective, 20–30, 126
surrogate, 30–42, 45, 126, 197–98
epinephrine, 223, 224
epoietin alfa, 231
eptifibatide, 240
esomeprazole, 239
eszopiclone (Lunesta), 148n
ethics, 162, 183, 189
of placebos, 26, 104
of randomized controlled trials, 104, 117, 119
of sham surgery, 24
evidence-based medicine (EBM), 4–6, 19, 21, 99–108, 111, 195
burden of proof and, 183–89
case-control studies, 106–7
cohort trials, 103–6
in diagnostic testing, 209–12
doctors’ explanation of evidence, 151
FDA approval process and, 142, 162
randomized controlled trials, 5, 101–3, 108, 110–22, 126
exercise, 71, 149, 180–81, 182
ezetimibe, 236, 241
FDA. See U.S. Food and Drug Administration approval process
feeling better, 15, 16, 19, 20–30, 45, 78, 80, 100. See also subjective end points
fenofibrate, 35, 36, 195
financial incentives, 4, 14, 17, 18, 95, 133–34, 141–42, 149, 155–56, 161, 175–76, 195, 213
Physician Payments Sunshine Act, 176
flawed data sources, 126, 134–47
conflicts of interest in practice guidelines, 140–42
FDA approval process, 142–47
industry-sponsored trials, 136–40, 176–77
flecainide, 12, 20
Flexner, Abraham, 165
Framingham Heart Study, 34
gabapentin (Neurontin), 146–47
Galileo, 128
Gall, Victor, 83
genomic medicine, 114–15
gentamicin-collagen sponge, 245
germ theory of disease, 129
Getzsche, Peter, 48n
Gleevec. See imatinib glucosamine, 71, 72, 75, 230
Government Accountability Office, 144
gown-and-glove precautions, 58–59, 60, 61, 63, 64n, 110
Groopman, Jerome, 94
hamstring surgery, 201
harmful practices/therapies, 2, 11, 12, 27, 68, 71, 86, 87, 101, 117
burden of proof and, 186, 187–88, 193
case-control studies of, 106
complementary therapies, 73, 74, 80
drug approval and, 145, 146, 185
genomic medicine and, 114–15
hormone replacement therapy, 3, 6, 103–5
inferior vena cava filter, 186
malpractice and, 184
placebos, 26
screening tests, 56
spinal-cord stimulators, 144
harms of medical reversal, 6–7, 18–19, 88–95, 161, 173, 195, 214
intracranial stents, 89–91
loss of trust in medical system, 93–94, 95
to patients undergoing therapy, 90–91, 95
refusal to abandon ineffective practices, 91–93, 95
withholding of beneficial therapies due to safety concerns, 94–95
Hartzband, Pamela, 94
Hawthorne effect, 62
health-care team, 59–60, 164, 167
rapid response, 63–64
heart attack. See myocardial infarction
heart failure, 14, 40, 93, 150, 154, 174, 221, 229, 235, 237–38
heart surgery in infants, 225
Heberden, William, 130
Helicobacter pylori infection, 129
Hemkens, Lars, 41
hemoglobin A1c (HbA1c), 30–34, 36, 41, 197, 232
hemophilia, 209
hepatitis C, 238
HIV/AIDS, 46, 144, 208, 218
Hodgkin’s lymphoma, 222
homocysteine, 230
hormone-replacement therapy, 2–3, 6, 103– 5, 132, 133, 195, 222, 223
Horwitz, Ralph, 112
hospitalization, 40–41
Humanitarian Use Device, 91
hydroxyurea, 227
hypercalciuria, 220
hypertension, 13, 30, 36, 100
atenolol for, 13, 20, 32, 36, 100
hypothesis generation and testing, 2, 4, 12, 99, 106, 126–27, 130, 131, 132, 165–66, 178, 191, 210
ibuprofen, 21
imatinib (Gleevec), 114
indomethacin, 219
industry-sponsored trials, 136–40, 176–77, 195
inferior-vena-cava (IVC) filter, 186
influenza, 136–38
inguinal hernia repair, 224
insulin therapy, 30–31, 67, 68, 236, 237
internal mammary artery ligation, 28–29
intra-aortic balloon pump (IABP), 39–40
in vitro fertilization, 233
Ioannidis, John, 82–83, 112, 118
irritable bowel syndrome (IBS), 26–27
IV catheter infections, 62–63
joint replacement surgery, 85, 156
Kaptchuk, Ted, 26
Kefauver-Harris Amendment, 185
Kepler, Johannes, 128
Kesselheim, Aaron, 139–40
knee arthroscopy, 22–23, 24, 28, 86, 221, 238
knee joint pain, 21–23, 230
Kuhn, Thomas, 127–33
Landsberger, Henry A., 62
lead chelation therapy, 219
leukoplakia, oral, 224
life expectancy, 6, 134
LIFE trial, 12n, 13
losartan, 13
Löwy, Ilana, 46
Lunesta. See eszopiclone
lung cancer, 188n
CT-scan screening for, 46, 47, 48–49, 54–55
smoking and, 105–6, 107, 108
lung disease of prematurity, 223
lung transplantation, 235
lymphedema, 181, 240
magnetic resonance imaging, 21, 90
malfeasance, 126, 142
malpractice claims, 18, 184–85
mammography, 11, 16–18, 20, 46, 47–48, 50, 51, 52–55, 93–94, 232
Marshall, Barry, 129
mastectomy, 221
prophylactic, 46
McKinlay, John, 4–5, 133–34, 162
mechanism of therapeutic action, 154, 165
Medicaid, 91, 213
medical-device industry, 136, 176, 192, 213
device approval process, 143–44, 185–86
medical education, 19, 85, 93, 161–72
anatomy courses, 166–67; “first, do no harm,” 4, 94, 117, 188
overcoming critics of revision, 170–71
proposed curriculum for, 172
rebuilding from ground up, 166–70
reductionist vs. empiricist approach to, 154–55, 165
rethinking foundations of, 164–66
and what makes a good physician, 163–64. See also academic medicine
medical innovations: probability of working, 187–88
stages in career of, 4–5, 133–34
medical reversal, 1, 6, 11–12, 125–26
Australian study of, 86–87
avoiding becoming victim of, 195–204
British Medical Journal Clinical Evidence study of, 86, 87
burden of proof and, 183–89
cases of, 12–18, 20
for complementary treatments, 74–75, 77
controversy about, 7
due to scientific progress, 125, 130–31
evidence-based medicine and, 4–6
harms of, 6–7, 18–19, 88–95, 161, 173, 195, 214
history of, 2–4, 6
impact of thought leaders on, 175
observational studies and, 105–6, 107, 108, 126, 134, 180, 181, 198, 205
and optimizing medical care, 2
12–14
Prasad-Cifu studies of frequency of, 81–87
scientific method and, 11–12, 125, 126–27, 131–32, 157
for screening tests, 54–55
summaries of reviewed studies of, 86, 217–45
of systems interventions, 61–64
of treatments that make people feel better, 20–30
useless research and, 181
Medicare, 15–16, 90n, 91, 101n, 145, 213
meningitis, bacterial, 235
MERIT trial, 64
meta-analyses, 5, 115, 120–21
metformin, 31, 237
methicillin-resistant Staphylococcus aureus (MRSA), 59, 61
metoprolol, 13, 14
Milwaukee Protocol for rabies, 112–13
monoclonal antibodies, 37
mortality, 8, 20, 31, 32, 76, 197
cholesterol level and, 34
hemoglobin A1c and, 31, 34
hospitalization and, 41
hypertension and, 13, 100
impact of cancer screening tests on, 46, 47, 48–49, 55
mammography for women in their forties and, 17–18
premature ventricular contractions and, 12
statins and, 141
multiple sclerosis (MS), 95, 99, 218
mupirocin, intranasal, 221
myocardial infarction (MI), 130–31, 231, 232
calcium supplementation and, 74
cholesterol and, 34
cholesterol-lowering drugs and, 6, 36, 199
coronary stenting and, 3–4, 130, 131
diagnostic tests for, 212
door-to-balloon time for, 65–67
estrogen and, 103–4
estrogen replacement and, 2, 3
flecainide after, 12, 20
hemoglobin A1c and, 31, 32, 34
intraaortic balloon pump and, 39–40
naltrexone, 220
National Center for Complementary and Alternative Medicine, 77
National Comprehensive Cancer Network (NCCN), 145
National Institutes for Clinical Excellence, 37–38
National Institutes of Health, 77, 138, 140, 176, 178, 203, 213
natural history of disease, 199
neuroblastoma, 220
neurocysticercosis, 220
Neurontin. See gabapentin niacin, 35–36, 166, 200–201, 241
nitric oxide, 83, 228
norepinephrine, 154, 236, 242
nudge principle, 191–93, 194, 206, 207
number needed to treat (NNT), 102, 199, 200
Nurses’ Health Study, 103–5, 107
obesity, 149–50
observational studies, 105–6, 107, 108, 126, 134, 180, 181, 198, 205
Offit, Paul, 77
off-label drug marketing, 142, 145–47
optimism, 93, 117, 155, 156, 161
optimizing medical care, 212–14
oseltamivir (Tamiflu), 136–38, 139, 144
Osler, William, 69
osteoarthritis of knee, 21, 29, 82, 86, 221, 230, 238
osteoporosis, 2, 3, 15, 71, 74, 174, 240
ovarian cancer, 225
pancreatic cancer, 106, 107, 180, 181, 241
Pap smears, 46, 47, 48