Reversal of established practices and other stories . . .

“Most of what you were taught in medical school was wrong,” we’re told. Minerva hopes this is no longer quite true, but a paper called “A Decade of Reversal” in Mayo Clinic Proceedings (2013, doi:10.1016/j.mayocp.2013.05.012) shows that there is still a lot of standard practice in all fields of medicine that doesn’t bear the scrutiny of well conducted trials. Vinay Prasad and colleagues carefully sought every trial published over 2001-10 in the New England Journal of Medicine, which contradicted standard practice at the time of publication. They found 146 such instances, and if you read through the many pages where these are described, you are bound to find a few that surprise you. Every doctor needs to remember the challenge of John Maynard Keynes: “When the facts change, I change my mind. What do you do?”

It is no secret that the pharmaceutical industry has a hold on many patient support organisations, and that many pharma companies are deeply uneasy about calls for …