Medical reversal

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Medical reversal refers to when a newer and methodologically superior clinical trial produces results that contradict existing clinical practice and the older trials on which it is based. This leads to an intervention that was widely used falling out of favor, because new evidence either demonstrates that it is ineffective or that its harms exceed its benefits. It is distinct from replacement, which occurs when a newly developed medical treatment supersedes an older, less effective one as the standard of care.[1] Medical reversals are caused when a treatment is widely adopted even when there is not compelling evidence for its safety and effectiveness. For example, an intervention may be adopted because it "makes sense", or because there are observational studies supporting its putative benefits.[2] Notable examples of medical reversals include hormone therapy, class 1C antiarrhythmic agents, and pulmonary artery catheters, all of which became less commonly used after trials found them to be either harmful or less effective than previously believed. The negative effects of such reversals include harm to patients who received the intervention when it was considered relatively safe and effective, as well as reducing public trust in medicine.[3] The term evidence reversal has also been proposed to refer to the same concept as medical reversal, but with a broader scope, including other scientific disciplines in addition to medical science.[4]


A 2011 study of one year of original New England Journal of Medicine publications found that 13% of them constituted medical reversals.[3] A 2013 study of a decade of medical journal articles found that of the 363 articles focused on standard of care practices, 146, or about 40%, led to reversals of the practice.[5] A 2019 study of over 3,000 randomized controlled trials published in three prominent general medical journals concluded that 396 of these trials constituted medical reversals. The most common disease category among the reversals identified was cardiovascular disease.[6]


  1. ^ Prasad, Vinay; Cifu, Adam (December 2011). "Medical reversal: why we must raise the bar before adopting new technologies". The Yale Journal of Biology and Medicine. 84 (4): 471–478. ISSN 1551-4056. PMC 3238324. PMID 22180684.
  2. ^ Cifu, Adam S.; Prasad, Vinay K. (December 2015). "Medical Debates and Medical Reversal". Journal of General Internal Medicine. 30 (12): 1729–1730. doi:10.1007/s11606-015-3481-5. ISSN 1525-1497. PMC 4636561. PMID 26224155.
  3. ^ a b Prasad, Vinay (2011-10-10). "The Frequency of Medical Reversal". Archives of Internal Medicine. 171 (18): 1675–6. doi:10.1001/archinternmed.2011.295. ISSN 0003-9926. PMID 21747003.
  4. ^ Sutton, Desirée; Qureshi, Riaz; Martin, Janet (February 2018). "Evidence reversal—when new evidence contradicts current claims: a systematic overview review of definitions and terms". Journal of Clinical Epidemiology. 94: 76–84. doi:10.1016/j.jclinepi.2017.10.004.
  5. ^ Prasad, Vinay; Vandross, Andrae; Toomey, Caitlin; Cheung, Michael; Rho, Jason; Quinn, Steven; Chacko, Satish Jacob; Borkar, Durga; Gall, Victor (2013). "A decade of reversal: an analysis of 146 contradicted medical practices". Mayo Clinic Proceedings. 88 (8): 790–798. doi:10.1016/j.mayocp.2013.05.012. ISSN 1942-5546. PMID 23871230.
  6. ^ Herrera-Perez, Diana; Haslam, Alyson; Crain, Tyler; Gill, Jennifer; Livingston, Catherine; Kaestner, Victoria; Hayes, Michael; Morgan, Dan; Cifu, Adam S (2019-06-11). Franco, Eduardo; Elshaug, Adam (eds.). "A comprehensive review of randomized clinical trials in three medical journals reveals 396 medical reversals". eLife. 8: e45183. doi:10.7554/eLife.45183. ISSN 2050-084X.