RT Journal
A1 Prasad V, Gall V, Cifu A
T1 THe frequency of medical reversal
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2011
FD October 10
VO 171
IS 18
SP 1675
OP 1676
DO 10.1001/archinternmed.2011.295
UL http://dx.doi.org/10.1001/archinternmed.2011.295
AB 
We use the term reversal to signify the phenomenon of a new trial—superior to predecessors because of better design, increased power, or more appropriate controls—contradicting current clinical practice. In recent years, a number of such reversals have occurred. Use of hormone therapy,1 the class 1C antiarrhythmic agents,2 and the pulmonary artery catheter3 have decreased when trials demonstrated that they are either less effective than previously thought or harmful. Reversal not only affects medications and diagnostic tests. Previously accepted indications for surgical and medical procedures have also been contradicted. In 2007, the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE)4 trial found no benefit to support percutaneous coronary intervention (vs optimal medical therapy) in many patients with stable coronary artery disease, an indication that was previously accepted. The implications of reversal are notable. Reversal implies error or harm to patients who underwent the practice in question, during the years it was considered effective. Reversal also undermines trust in the medical system. We sought to estimate the frequency of reversal by examining 1 year of original publications in the New England Journal of Medicine.