Forever Changing and Improving? A Story on Medical Reversal

Ryan Argetsinger, 8/18/24

  Every proceeding year, thousands of medical students enter their residencies, bringing in the knowledge and skills taught to them from the past four years of medical school. They bring an energy and curiosity that keeps them expanding and hoping to be able to apply themselves to fulfill their main purpose–to serve those in need. However, if there’s one thing that physicians who have practiced for years on end understand about medicine, it’s the fact that the field, the science, is always changing. Medicine, like the people it treats, is a living and updating continuum. That’s why research is such an important factor in medicine because of the fact that it allows physicians to understand what practices improve the quality of patient care, and which come at the detriment of the patient, as well as the medical community. 

Stenting for stable coronary artery disease was thought to be a practical practice throughout medicine, which also brought in multibillion-dollar procedure costs; however, it was disproved and found to be detrimental to patient health. Hormone therapy for postmenopausal women was found to be worse than no intervention, which also did not improve cardiovascular outcomes. Arthroscopic surgery for knee osteoarthritis was called into question and eventually overturned when it was found to have little to no effect on patient wellness. 

Although these practices are no longer in use, at what point do we ask ourselves: why on Earth did they begin in the first place and why were they utilized? The truth behind this matter is due to several factors: but the Yale Journal Of Medicine uses three suggestions. The idea that harmful practices are in place suggests an inadequacy of understanding. Doctors understand that their patient's health and well-being are placed above everything else, which is why physicians provide the best care of their known knowledge. When reversal comes about and replacement ensues, the patients are relieved of a potential hazard, and given an updated form of treatment, based on medical research, which is why physicians can always assume to have continuing education and always be learning.

The other factor to consider is the social effects of reversal. Medical reversal can cause distrust for the patients who have received care from a treatment that has been proven to be reversed, which disintegrates the relationship between patients and the medical community. It’s important for patients, as well as physicians, to understand that physicians are doing the best that they can to treat them, however, physicians are always discovering the answers that they wish to have. 

And lastly, the financial implications of medical reversal. Medical procedures that have been established and bring in money, such as coronary stents, can be hard to remove because of the financial implications. What isn’t discussed is the cost saved by physicians, patients, and the medical industry when reversal takes place and replacement is utilized. By saving patients from a procedure being reversed, the cost of supplies, as well as time for service, and treatment allow for more efficient procedures that can service more patients (hopefully). 

The reason for these types of reversals is the need for answers. Randomized control trials in the clinical setting of biomedical research are what provide treatments for most to all patient-based procedures. However, the statistical power and sample size of these populations are what provide a weakened result for a clinical practice, which is why research needs to be regulated further to maintain the quality of results for the sake of patient care. Medical reversals are going to always be a part of the medical field, but it’s the duty of physicians and researchers to develop stronger methods of efficiency to obtain strong and safe outcomes.

References

Mayo Clinic, "A Decade of Reversal"

https://www.mayoclinicproceedings.org/article/S0025-6196(13)00405-9/fulltext 

NCBI, "Medical Reversal: Why We Must Raise the Bar Before Adopting New Technologies"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3238324/