Ineffective Drugs, Surgeries, and Other Medical Treatments

Some medical practices may be entirely ineffective or even harmful. This is not just an individual viewpoint. A team of physicians and researchers conducted an analysis of over 3,000 trials published in prominent medical journals and shared their discoveries. If you are using medication or facing a medical procedure, it is crucial to be well-informed.

Causing Harm and Undermining Trust

The comprehensive evaluation was spearheaded by Dr. Vinay Prasad, a hematologist-oncologist and Associate Professor of Medicine at Oregon Health and Science University. The findings were published in eLife in June. Dr. Prasad and nine other team members scrutinized studies published between 2003 and 2017 in three renowned medical journals: the Journal of the American Medical Association (JAMA), the Lancet, and the New England Journal of Medicine. They pinpointed 396 common practices that are considered reversals in medical terms, signifying that they are either no more effective than standard procedures or are as useful as or even inferior to placebos (meaning they are no better than nothing, or potentially worse). The most prevalent reversals were associated with drugs, with cardiovascular disease being the discipline with the highest number of reversals. Interestingly, new interventions frequently do not outperform existing ones. Medical reversals often relate to new drugs or procedures. In addition to the team's recent discoveries, a previous review highlighted 146 reversals in studies examined between 2001 and 2010. Illustrative examples of reversals include:

• Uveitis surgery performs more poorly than current medications
• Insomnia medications yield inferior results compared to cognitive behavioral therapy
• Thigh-length compression stockings either do not affect or exacerbate the risk of deep vein thrombosis post-stroke
• Mammography screening every one to two years for women aged 40–49 is unwarranted
• Hip protectors are ineffective at preventing hip fractures in individuals over 70
• Wearable weight loss technologies reduce the chances of successful weight loss
• Meniscal cartilage tear surgery is no more effective than physical therapy

The researchers suggest that such practices "can lead to physical and emotional harm [and] erode public trust in medicine." Moreover, they note that “once an ineffective medical practice is established, it is challenging to persuade practitioners to discontinue its use.” They further explain that eliminating such practices “takes time and encounters resistance.”

New, Pricey Cancer Drugs Not Necessarily Better

Two separate articles on new versus existing cancer drugs were published in JAMA Internal Medicine in May. The first study revealed that out of the 93 new cancer drugs granted accelerated approval by the FDA in the 25 years up to 2017, only 19 exhibited any enhancement in overall survival over existing drugs, yet merely five out of the 93 have been withdrawn. The second study criticized the approval of new cancer drugs based on tumor shrinkage rather than focusing on clinical benefit as the preferred outcome. (It is common for cancer treatments, both traditional and alternative, to reduce tumor size without extending survival time.)

Should Unproven Drugs Be Marketed?

In an editorial regarding these two studies, Dr. Ezekiel Emanuel from the University of Pennsylvania and two colleagues pointed out that the FDA is overly eager to approve drugs without sufficient evidence of their efficacy. They state, "Drugs lacking proven effectiveness provide false hope to desperate patients, who often pay substantial amounts out of pocket for them. "High drug prices are already concerning for effective treatments. Charging vulnerable patients for drugs lacking evidence of improving survival and quality of life is unjustifiable." To be fair, patients and their families exert immense pressure on the FDA and policymakers to permit the use of unproven drugs in cases with a very bleak prognosis (essentially, no hope). Similarly, authorities face pressure to lower the evidentiary threshold for drugs designed to treat rare diseases affecting a small number of individuals. Generally, it is not financially viable for pharmaceutical companies to invest vast sums in bringing these experimental drugs to market.

The Destructive Role of Government

In my opinion, pharmaceutical companies should be mandated to demonstrate that a drug is safe, not necessarily effective. This would enable numerous alternative treatments to be legally distributed and utilized for disease management as deemed appropriate by the physician and patient. The FDA evaluates copious clinical data, case studies, and even placebo-controlled trials for various treatments labeled as “unproven.” 

The FDA requires an extensive series of trials that frequently yield inconclusive results but incur substantial costs. In reality, many of the treatments categorized as “unproven” are often effective, while the proven “treatments” frequently fall short. Because the FDA demands both safety and efficacy for a treatment – along with numerous other bureaucratic obstacles – the process of bringing a new drug to market becomes exorbitantly expensive, rendering it unfeasible for most alternative treatments. The approval process for cancer drugs, in particular, is essentially a facade. A cancer drug only needs to add a few more months – or even weeks -- to a typical patient’s life to be hailed as “new and improved.” The truth is that it is no better than existing off-patent and inexpensive drugs. The trial where the new drug outperformed the existing one was likely just a statistical anomaly. There is also evidence indicating that chemotherapy for advanced cancer does not prolong life. These patients might fare better with no treatment or alternative approaches. Nonetheless, the deception persists, resulting in billions of dollars being spent on treatments that exacerbate patient suffering rather than alleviating it. The FDA’s rigorous approval process is the primary driver behind the steep costs of drugs, plunging patients into financial ruin.

Summary

 

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1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559784/
2. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2733561
3. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2733563
4. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2733557?resultClick=1