Ending Medical Reversal Quotes

“Empathy and the ability to anticipate a patient’s changing needs are the hallmarks of an excellent physician.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“If the evidence is one doctor’s experience or an observational study—you should doubt it. You would like the evidence to come from a randomized trial done at hospitals across the country.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“This means continuing to learn from their patients and from the medical literature until the day they retire. We call this practice-based learning”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“Not only do our doctors need to be experts in working with patients; they need to work within the growing health-care team in a facile manner.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“What then can we say about the doctors we want our medical schools to produce? Tomorrow’s doctor probably needs to master three areas while in medical school: the doctor-patient relationship, systems-based practice, and practice-based learning.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“The United States is one of only two nations that permit the DTC marketing of medical products. Besides being annoyed by some of the advertisements, many people do not see a problem with DTC advertising of prescription drugs.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“Or be really ambitious and recognize that weight is just a surrogate end point. Can you test whether once-per-hour standing at work will improve quality of life or decrease the incidence of disease or mortality?”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“Recently, one of us noticed a worrisome discrepancy in a trial comparing two drugs. The trial called for doses of the drugs to be reduced if patients experienced prespecified adverse effects. When the trial started, the two drugs were dosed equivalently, but if a patient required a dose reduction, the dose of the industry drug fell a bit, while the dose of the comparison drug fell a lot. This kind of trial design does not routinely set off any warning bells—the bias in the design is easy to miss—but it shows how hard it is to develop a scale to catch all the small ways a trial may be biased.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“An investigation published in the BMJ in 2008 compared industry-sponsored trials to trials paid for by other entities. The authors found that industry-sponsored studies were more likely to reach positive conclusions regarding the benefits or cost-effectiveness of a therapy and more likely to test a new therapy against a placebo (as opposed to a real competitor). When considering both original trials and meta-analyses, industry-sponsored studies are four times as likely to reach a positive conclusion.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“The case of Tamiflu is another example of medical reversal, a therapy adopted into widespread use that is later found to be no better than our previous less expensive and safer therapy”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“In 1981 health-care spending in America as a percentage of GDP was 8 to 9 percent, while in 2014 that number is 18 to 20 percent. As many have noted, all these dollars have not yielded a proportionate increase in life expectancy, and in that sense the United States lags behind many other industrialized nations who spend less.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“Publication bias occurs because small positive RCTs are more likely to be published than small negative ones. Thus, the medical literature as a whole tends to be biased toward positive results, and meta-analyses will reflect this bias. Finally, if several medium-sized randomized trials and a meta-analysis agree that a treatment is beneficial, then that finding is probably really true.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“We do not know that drinking more caffeine puts women at higher risk for miscarriage. We only know that women who ingest more caffeine are more likely to miscarry. It might be the caffeine, or it might be the aggravation caused by their local Starbucks’ barista.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“Lastly, the results of a single RCT do not provide a sort of biblical truth. What they do is present strong evidence about a finding; evidence that often becomes more nuanced as later RCTs examine the same question.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“High blood pressure is bad. It increases the risk of death. Atenolol lowers blood pressure, but it does not lower the risk of death. The evidence supporting the claim that hypertension increases your risk of death is very different from the evidence proving that using atenolol to decrease your blood pressure lowers your risk of death.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“the average doctor, who did complete medical school, is still woefully undertrained to think about evidence.)”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“The same group of researchers who studied the articles about COURAGE also analyzed the medical literature to discover just how long it takes the medical community to abandon a practice after a therapy is proven ineffective. They tracked citations to three major practices that were found not to work: beta-carotene to prevent cancer; estrogen to prevent Alzheimer’s disease; and vitamin E to lower cardiovascular risk. They found that 10 years passed before the research community stopped referencing the flawed practice. This estimate of a decade of inertia fits with our own experience. It takes that long for the train of medical practice to stop.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“British Medical Journal Clinical Evidence completed a review of 3,000 medical practices. Those researchers found that 35 percent of medical practices are effective (or likely to be effective); 15 percent are harmful, unlikely to be beneficial, or a tradeoff between benefits and harms; and 50 percent are of unknown effectiveness.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“There is also the issue of money. There is little incentive to attempt to overturn a practice from which you are profiting. Not many orthopedists would be willing to investigate whether joint replacement is better than a sham procedure. They believe in the procedure and are making a handsome profit from it.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“Unfortunately, supplementing calcium and vitamin D seems to not help. Similar to the stories above, recent analyses of randomized trials find that calcium and vitamin D supplementation does not reduce the risk of fractures among healthy women. For this reason, the U.S. Preventive Services Task Force (USPSTF) now recommends against the supplements.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“The study found that between 2005 and 2009, door-to-balloon times were reduced across the nation; the number of patients waiting longer than 90 minutes decreased from 40.3 percent to 16.9 percent. Unfortunately, mortality was completely unchanged over this time period. Figure 5.1 displays in a striking way the decline in door-to-balloon time graphed against the unchanging mortality. Our tremendous and costly efforts improved door-to-balloon time but did not yield improvements in survival.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“A 2006 study published in Lancet found that mammograms did not improve breast cancer mortality among women in their forties in the United Kingdom. A study from Canada published in 2013, covering a wider age group, showed similar results. And these studies dealt with breast cancer mortality, not the more important overall mortality. Recent trials in prostate cancer have followed a similar trajectory.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“Maybe screening for prostate cancer decreases prostate cancer deaths but increases deaths from heart attacks. To understand how this might happen, we must turn to the second concept of cancer screening: overdiagnosis.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“Throughout this book, we make the case against surrogate end points. We argue that the way to prevent reversal is to have good evidence that medical practices improve hard end points—the ones that we care about. It is entirely possible that we will someday have perfectly reliable surrogate end points, but that achievement will involve a great deal of hard work.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“Since patients are hospitalized because they are doing poorly, many doctors believe that the end point that matters most for these people is a decrease in hospitalization.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“Surrogate end points, however, unlike clinically important objective end points, are invisible to the patient. They are stand-ins. We use them because it is simpler to show that a treatment improves a surrogate end point than to show it improves a real clinical one.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“... be skeptical of any nutritional claims; they are unlikely to be from randomized trials and may soon be proved wrong.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives

“The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.”
― Vinayak K. Prasad, Ending Medical Reversal: Improving Outcomes, Saving Lives