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Ending medical reversal

The first thing I picked up after taking the hematology boards was this gem from Chicago's medical royalty (Adam Cifu) and everyone's favorite oncologist (this is of course a joke — you know that people hate your guts, Vinay).

I didn't, and still don't, care much for the title. It is ambiguous: if medical reversal means overturning an established practice that was based on weak to no evidence once stronger evidence comes along — usually in the form of a (multi-center, blinded) randomized controlled trial — why on earth would you want to end reversals? Well, the book is about how to stop those kinds of practices from becoming established in the first place, which would indeed end medical reversal, but an easier way to stop them and one that would be endorsed by most of industry and many researches would be to just not look. "Ending Medical Reversal the Hard Way" is therefore a more appropriate name.

Title aside, I agreed with pretty much everything they wrote, from reforming medical education, through stopping direct-to-consumer marketing and direct-to-academic (not their words) payments, to having more people participate in (simpler, cheaper, and fairer) randomized trials. I enjoyed their honesty and clear style, and wished my medical school had at least a passing resemblance to the one they proposed (if you thought US medical education leaned too much on basic science-oriented and was heavy in professorial mechanistic proclamations, try the average European med school). Granted, I work in a federal research hospital and focus on some of the rarest of the rare diseases; but that only makes me shake my head in disbelief more when my colleagues who specialize in breast or lung cancer, not to mention coronary artery disease and diabetes, randomize enormous numbers of patients to search for minute differences in surrogate outcomes.

Written by Vinayak Prasad and Adam Cifu, 2015

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