Drs. Adam Cifu and Vinayak Prasad published Ending Medical Reversal: Improving Outcomes, Saving Lives in 2015. We found it eye-opening back then, and its central argument still holds up.
Medical reversals are complicated and detrimental to healthcare providers and patients alike.
[Related: Defending Your Medical License Against Misdiagnosis Claims]
What Is Medical Reversal?
Prasad and Cifu coined the term “medical reversal” to describe a specific pattern:
- A physician adopts a medication, procedure or diagnostic tool based on plausible physiology.
- Years later, a well-designed trial shows it never worked or worked no better than doing nothing.
They define medical reversal as the abandonment of a practice after new evidence shows that it offers no benefit over an older, cheaper or less invasive standard or that it causes outright harm.
The pattern differs from ordinary medical progress, where a better treatment simply replaces an adequate one. A reversal means the original treatment should never have become the standard in the first place.
For patients trying to keep up with the “latest and greatest” in medicine, that whiplash is disorienting. For the doctors who prescribed or performed the reversed treatment in good faith, it can raise uncomfortable questions. One of which is whether their prior practice was potentially harmful.
The authors aren’t outside critics; both are practicing physicians. Prasad is a hematologist-oncologist, and Cifu is a general internist. They built the book on published clinical trial data rather than anecdotes.
A Five-Step Framework for Patients
The book closes with a five-step framework to help patients evaluate whether a treatment a doctor recommends is worthwhile.
That framework includes questions about whether it’s proven to affect outcomes patients care about and how to find a physician open to that kind of dialogue.
You can find the full framework in the book, available through Johns Hopkins University Press and other retailers.
[Related: Facing Charges of Unlicensed Practice in Illinois]
Examples of Medical Reversal in Modern Medicine
The book walks through case after case of treatments that became standard practice before the evidence supported them. These are a few examples:
- Coronary stents placed in patients with stable coronary artery disease, later shown to offer no advantage over medication alone
- Vertebroplasty for spinal compression fractures, later shown to work no better than a sham procedure
- Arthroscopic surgery to repair degenerative meniscal tears, later shown to work no better than physical therapy
- Flecainide to suppress irregular heartbeats after a heart attack, later shown to increase the risk of death
- Hormone replacement therapy after menopause, later shown to raise cardiovascular risk in some patients rather than lower it
Respected clinicians once considered each sound, evidence-based care. Each one changed after a randomized trial caught up with practice already in wide use.
[Related: Medical Malpractice Lawsuits and Your Illinois Medical License]
Why Medical Reversals Happen
Prasad and Cifu trace most medical reversals to two recurring problems:
- Providers adopt a treatment on the strength of a small, poorly designed study.
- Financial interest in the outcome shapes a study.
There’s a third, more counterintuitive factor.
The authors argue that a treatment’s common-sense appeal (the more obviously it seems like it should work) correlates with a higher chance experts eventually reverse it once someone finally tests it properly.
[Related: Actions To Avoid if Your Professional License Is Under Investigation]
What Medical Reversal Means for Illinois Healthcare Professionals
The standard of care isn’t fixed. It moves as new trial data comes in, sometimes overturning practices that you once considered appropriate for years.
That reality matters for any physician, nurse or other licensed professional whose care undergoes review after the fact. That might be by a malpractice attorney, a hospital committee or the Illinois Department of Financial and Professional Regulation (IDFPR).
An IDFPR complaint doesn’t automatically mean you fell short of the standard of care at the time you treated patients. But two actions demand informed legal representation before the Illinois State Medical Board:
- Responding to that complaint
- Explaining the state of the evidence as it existed when you made a treatment decision
It’s not a situation where you want to go solo.
[Related: Does an Illinois Physician Have to Submit to Questioning by an IDFPR Investigator?]
Contact Williams & Nickl for Medical License Defense
Practicing medicine means making judgment calls with the best evidence available at the time, and that evidence changes. If a past treatment comes under scrutiny, we bring the same rigor to your defense that Prasad and Cifu bring to clinical evidence.
At Williams & Nickl, we know how the IDFPR and Illinois Medical Board tick. And we’ve got your back.
Contact us online or call 312-335-9470 to schedule a free, confidential 1-hour consultation.
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