Subjects

Vinay K. Prasad, M.D.

Assistant Professor of Medicine at the Oregon Health and Sciences University

Co-author of Ending Medical Reversal: Improving Outcomes, Saving Lives

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Biography

Dr. Vinay K. Prasad's work has demonstrated that a large percentage of medical procedures, diagnostic tools, and medications are destined to be found useless — or even harmful — to patients. To describe the instances where common or established healthcare practices or therapies are found faulty and, as a result, discontinued, he uses the term medical reversal.

Medical reversals occur when testing is not adequate and there is actually little or no evidence to support the efficacy of a therapy, screening, or drug. As these are often sound in theory and well entrenched by the time they are proven flawed, their elimination from prescription commonly takes years. They jeopardise patient health and waste limited healthcare resources long after the reversed practices are proven ineffective, and they erode overall trust in the medical community.

Dr. Prasad takes fascinating examples from nearly every medical specialty — such as the arthritis drug Vioxx, female hormone replacement therapy, and mattress covers for dust mite allergies — to explore "advances" that turned out to be dangerous or useless. He explains how current healthcare industry and media support the establishment of ultimately "reversed" practices, and he outlines a comprehensive plan to reform medical education, research funding and protocols, and drug approval processes to help prevent them. To further help ensure that more of what gets done in doctors’ offices and hospitals is truly effective in improving outcomes, he provides suggestions for patient scrutiny and advocacy.

Vinay K. Prasad MD / MPH is a hematologist-oncologist and Assistant Professor of Medicine at the Oregon Health and Sciences University. He holds appointments in the Division of Public Health and Preventive Medicine, and as a Senior Scholar in the Center for Health Care Ethics.

A graduate of the University of Chicago Pritzker School of Medicine and recipient of their Chairman's Award in Internal Medicine, Dr. Prasad trained in general internal medicine at Northwestern University in Chicago where he received the Gerald Grumet award for best resident teacher. He completed his fellowship in Hematology and Oncology in the joint program between National Cancer Institute, and National Heart, Lung and Blood Institute both at the U.S. National Institutes of Health, where he was also a Cancer Prevention Fellow, and he holds a Masters of Public Health from the Johns Hopkins Bloomberg School of Public Health.

In addition to being co-author, with Dr. Adam Cifu, of Ending Medical Reversal: Improving Outcomes, Saving Lives (Johns Hopkins University Press, 2015), Dr. Prasad has written extensively for publications including the New England Journal of Medicine, the Journal of the American Medical Association, The New York Times, and The Washington Post.

Books

Ending Medical Reversal

Improving Outcomes, Saving Lives

Vinayak K. Prasad and Adam S. Cifu

We expect medicine to progress in an orderly fashion, with good medical practices being replaced by better ones. But some tests and therapies are discontinued because they are found to be worse, or at least no better, than what they replaced. Medications like Vioxx and procedures such as vertebroplasty for back pain caused by compression fractures are among the medical "advances" that turned out to be dangerous or useless. What Dr. Vinayak K. Prasad and Dr. Adam S. Cifu call medical reversal happens when doctors start using a medication, procedure, or diagnostic tool without a robust evidence base ― and then stop using it when it is found not to help, or even to harm, patients.

Drs. Prasad and Cifu narrate fascinating stories from every corner of medicine to explore why medical reversals occur, how they are harmful, and what can be done to avoid them. They explore the difference between medical innovations that improve care and those that only appear to be promising. They also outline a comprehensive plan to reform medical education, research funding and protocols, and the process for approving new drugs that will ensure that more of what gets done in doctors’ offices and hospitals is truly effective.

Johns Hopkins University Press; 1 edition (22 Sept 2015)

Reviews

Book Review: 'Ending Medical Reversal' Laments Flip-FloppingNew York Times
Ending Medical Reversal is Revolutionary — Dr. Kenny Lin, Common Sense Family Doctor
PrQ&A: Peventing Flip-Flops in Clinical Practice — MedPageToday.com
How Evidence Can Clean the House of Medicine — MedPageToday.com

Praise

An outstanding, genre-defining work, this book will be read by students, educators, policymakers, scientists, scholars, medical skeptics, and health-care pundits alike.
— John Henning Schumann, MD, host of Public Radio Tulsa's Medical Matters

An important book that frames medical reversal in a compelling way. Readers will be drawn to this clearly written account.
— David S. Jones, MD, Harvard University, author of Broken Hearts: The Tangled History of Cardiac Care

Dr. Prasad and Dr. Cifu offer a five-step plan, including pointers for determining if a given treatment is really able to do what you want it to do, and advice on finding a like-minded doctor who won’t object to a certain amount of back-seat driving. Of course, there are no guarantees that their tips will endure forever, but they probably have a longer shelf life than most medical advice.
New York Times

... when I describe Ending Medical Reversal as revolutionary, I don't use the term lightly. Go out and read it — right now.
Common Sense Family Dr.

Videos

A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices