Should Evidence Come with an Expiration Date?
It is not unusual for accepted therapies to be abandoned in the face of new evidence. Usually, this occurs as a medical reversal, when a therapy adopted without strong evidence is later shown to be ineffective in a well-designed randomized trial. Sometimes, however, therapies once supported by robust evidence are proven to no longer work. The basis of this declining efficacy is diverse but includes changing population risk, newly adopted adjunctive medical therapy, and, for screening interventions, more effective treatments, which obviate the gains from early detection. Recently published trials showing aspirin’s lack of efficacy in the primary prevention of cardiovascular disease (CVD) offer an example of this phenomenon. The lesson of aspirin for primary prevention is a broad one. What was once well-supported by data may prove ineffective in the future. Conversely, some interventions found to be ineffective may have worked if tested a decade earlier. We propose an “evidentiary...
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Conflict of Interest
Dr. Prasad reports receiving royalties from his book Ending Medical Reversal; that his work is funded by the Laura and John Arnold Foundation; that he has received honoraria for Grand Rounds/lectures from several universities, medical centers, and professional societies and payments for contributions to Medscape. Dr. Cifu reports receiving royalties from his books Ending Medical Reversal and Symptom to Diagnosis: An Evidence Based Guide. All remaining authors declare that they do not have a conflict of interest.
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