Science-based medicine is partly an exercise in detailed navel gazing – we are examining the use of science in the practice of medicine. As we use scientific evidence to determine which treatments work, we also have to examine the relationship between science and practice, and the strengths and weaknesses of the current methods for funding, conducting, reviewing, publishing, and implementing scientific research – a meta-scientific examination.
There have been several recent publications that do just that – look at the clinical literature to see how it is working and how it relates to practice.
Dr. Vinay Prasad led a team of researchers through the pages of the New England Journal of Medicine hunting for medical reversals – studies that show that current medical practice is ineffective. Their results were published recently in the Mayo Clinic Proceedings:
Dr. Prasad’s major conclusion concerns the 363 articles that test current medical practice — things doctors are doing today. His group determined that 146 (40.2%) found these practices to be ineffective, or medical reversals. Another 138 (38%) reaffirmed the value of current practice, and 79 (21.8%) were inconclusive — unable to render a firm verdict regarding the practice.
Prasad also found that 27% of published studies looked at existing treatments while 73% studied new treatments.