10 Medical Practices that Aren’t Worth the Money

There are plenty of media reports about exciting advances in medicine. But those same outlets seem to go silent when what had initially appeared to be a breakthrough fails the next round of studies. It happens surprisingly often. This becomes a problem when practioners don't keep up with current research. They may continue to use older treatments or procedures, even after those interventions have been shown to be ineffective or even harmful. The Mayo Foundation for Medical Education and Research recently set out to address this problem.  Their team, led by Dr. Vinay Prasad, looked at ten years of research articles published in a top journal to examine how many of the treatments, procedures, tests, surgeries, screenings, medications or other interventions in use today have truly been shown to work. Only 38% of articles evaluating established treatments found them to be beneficial. More than 40% of the published studies looking at an established treatment found it to be no better than or worse than the standard practice. To be clear, this doesn’t mean that 40% of procedures were ineffective. It means that in 40% of the studies reviewed, earlier positive results were superseded by later studies that reversed initial findings. To disprove earlier work a new study had to be more rigorously designed, better powered or better controlled.

Here are some of the practices that didn't pass that second look: 

1)  Prolonged antibiotic treatment for persistent symptoms of Lyme disease.  A 90-day course of antibiotics didn’t lead to patient improvement in a randomized, placebo-controlled trial.

2) The use of mite-allergen impermeable mattress pads and pillow covers to prevent asthma in adults. A double-blind, placebo-controlled and randomized study done in 2003 found this type of bedding had no impact on asthma symptoms.

3) Aggressive control of blood sugar to prevent heart disease.  A large 2008 study found that intensive glucose lowering in diabetics actually increased mortality and did not prevent cardiac problems. Adhering to more permissive glucose targets gave patients better outcomes.

4) Naltrexone to treat alcoholism.  A multi-center, randomized  and placebo-controlled study failed to find that naltrexone, an opioid-receptor antagonist, added any benefit to standard psychosocial treatment.

5) Antibiotics for asymptomatic UTIs in diabetic women.  In 2002 a randomized trial found that antibiotics did not reduce diabetic women’s time to symptomatic infection, or the number of complications due to urinary tract infections.

6) Arthroscopic surgery for osteoarthritis of the knee. Two controlled studies failed to find benefit from this procedure.

7) Hypothermia during aneurysm surgery. The Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) found in 2005 that cooling patients during neurosurgery for aneurysm provided no post-operative neurologic benefit.

8) High-dose chemotherapy with autologous stem-cell transplants for high-risk breast cancer. Even though this procedure reduced cancer relapse rates in the affected breast/axillary area , a randomized trial failed to find that it increased survival rates compared to conventional adjuvant chemotherapy.

9) Preimplantation genetic screening for IVF. Genetic screening during in vitro fertilization  for women of advanced maternal age was studied in a multicenter, double-blind study. The researchers concluded that preimplantation genetic screening actually reduced the number of pregnancies and live births.

10) Inserting stents in patients with coronary artery infarction. In a randomized trial of people who had suffered total blockage of an artery (myocardial infarction), patients were randomly assigned to a group who received either optimal medical therapy or optimal medical therapy with stents.  The stented group did no better in terms of survival rate, reinfarction or heart failure.

Read the Study: A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices
By Vinay Prasad,MD; Andrae Vandross, MD; Caitlin Toomey, MD; Michael Cheung, MD; Fason Rho, MD; Steven Quinn,MD; Jacob Chacko, MD; Durga Bonkar, MD; Victor Gall, MD; Senthil Selvaraj, MD; Nancy Ho, MD; and Adam Cifu, MD

How High Performance Organizations Get the Most Out of Training

Best Practices from the Science of Training

Training works, if it is well designed.  Researchers have been studying training methods for 40 years now, and they've got robust evidence to show that done right, training boosts organizational effectiveness. NASA and the US Navy recently sponsored a study to find out what cognitive science, engineering, and industrial psychology have taught us in the last few decades. The project’s lead author, Eduardo Salas at the University of Central Florida, found that it’s crucial for training systems to be properly integrated into the organization. His report identifies the keys to spending training dollars wisely.

1.  It may seem obvious, but the first thing to consider is whether you really need training at all. Decide if the issue is actually structural or organizational. If it is, don’t waste time and money throwing training at problems it won’t fix.

2.  Do a needs assessment. What are organizational needs, and then what skills, knowledge or competencies are required to fulfill those needs?  Make sure that the training program is tailored to these needs.  There are lots of fads and glitzy technological delivery systems out there but only use training programs that have measurable effects on job performance.

3. Do a personnel assessment. Identify which employees have the greatest gap between  competencies and requirements and focus on those employees. Don’t train everybody unless there is a specific reason to.  

4. Make sure the training is suited to the needs of those whose skills need upgrading. Older workers, for example, may require a slower pace to master new technologies.

5.  Teach supervisors how to focus on training’s benefits and make sure it is regarded positively within the organization.  Introduce training as an opportunity to advance the employee’s career, not as a test or an indictment of his or her incompetence. On the other hand, don’t oversell it. Unrealistic expectations lower performance.

6.  Maximize learning by not overloading trainees with too much content. Focus on what is crucial to know and how to access the rest.

7. Teach error tolerance. Build in difficulties and challenges so that trainees have the opportunity to fail.  Good training teaches emotional as well as cognitive skills. Employees need to become comfortable with detecting and correcting their own errors.

8. Model proficiency and competence with the new material or skill, and make sure the training includes practice and feed-back. 

9.  Create ongoing learning by debriefing afterwards and linking trainees into communities of practice.

10.  Minimize skill decay by scheduling training as close to its application as possible. 

Read the Study: The Science of Training and Development in Organizations: What Matters in Practice  (free)
By Eduardo Salas, Scott J. Tannenbaum, Kurt Kraiger, and Kimberly A. Smith-Jentsch