Mar 192012

This post was featured on; an excerpt follows:

An essay in JAMA by Vinay Prasad (Northwestern of Chicago), Adam Cifu (U. of Chicago) and John Ioannidis (Stanford) should be required reading for every medical student, resident, and to pass every board certification exam in any specialty. In my humble opinion.

John Ioannidis became one of my personal heroes with the publication of his great paper in PLoS Medicine, "Why Most Published Research Findings Are False," and its followup Atlantic magazine profile ("Lies, Damn Lies, and Medical Science"). Rather than being nihilistic, Ioannidis's essay is an elegant statistical proof that makes the simple point that bias and error are inevitable, and rampant in the published body of medical literature.

Here they advise us to consider "When To Abandon Ship," i.e., reverse failing medical practice, using the same direct, unadorned, and courageous prose:

How many established standards of medical care are wrong? It is not known. Medical practice has evolved out of centuries of theorizing, personal experiences, bits of evidence, expert consensus, and diverse conflicts and biases. Rigorous questioning of long-established practices is difficult. There are thousands of clinical trials, but most deal with trivialities or efforts to buttress the sales of specific products. Given this conundrum, it is possible that some entire medical subspecialties are based on little evidence...

(Read the rest of the post at

Prasad V, Cifu A, Ioannidis JPA. Reversals of Established Medical Practices. Evidence to Abandon Ship. JAMA 2012;307:37-38.

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Is half of current medical practice just plain wrong? (Essay, JAMA)