A medical reversal is when new research leads to a complete change in a medical practice or treatment that was previously widespread. Often this is a result of new, better designed studies which ultimately contradict current practice.
Here are just a few examples:
- Hormone replacement therapy (HRT): For many years, HRT was recommended for postmenopausal women to counteract the effects of aging and help prevent heart disease. That practice was stopped when it was considered way too risky due to its association with an increased risk of certain cancers, stroke, and blood clots. But more recent research has shown that HRT has complex risks and benefits, and it is again being recommended to some women. It is still considered inappropriate for the prevention of chronic disease in postmenopausal women (1).
- Knee surgery: Arthroscopic knee surgery for meniscal tears in patients older than 45 with osteoarthritis was commonly performed prior to studies showing that these patients do better with a non-surgical approach that includes physical therapy (2, 3).
- Use of MRI testing for back pain: MRI testing was once routinely done for people with low back pain until a group of researchers found that a large sample of people with no complaint of back pain also had herniated discs in their spine. Now, conservative management including physical therapy, is almost always prescribed first (4).
- Screening for Vitamin D: a recent reversal:
The new guidelines for vitamin D testing and supplementation presented by the Endocrine Society on June 3, 2024 includes advising against routine testing of vitamin D levels in healthy people (5).
They state that most adults aged 19 to 70 years should receive 600 IU daily vitamin D, and that should be increased to 800 IU for adults older than 70. The recommendation includes vitamin D intake from dietary and supplemental sources. This aligns with the recommendations from the National Academy of Medicine.
These guidelines are the result of a comprehensive assessment and systematic review of the evidence, yet they have already sparked significant controversy (6).
My Thoughts:
I find it reassuring that medical researchers continue to re-evaluate older, well-established ways of doing things. Even if this sometimes results in a “flip flop” and may cause our confidence in the medical system to be temporarily undermined, we must remember that in most cases, the new recommendations are simply a reflection of the scientific process. This is a good thing! Let’s read the latest medical news with a critical eye and an open mind, and expect that as we learn, medical practice will continue to evolve.
Lastly, keep in mind that there is a growing body of medical research which consistently shows the importance of EXERCISE to many, many aspects of our health and well-being. There have been no reversals. The body of evidence just continues to grow.
See you in Strong Bones class!
- Manson JE, et al. The Women’s Health Initiative Randomized Trials and Clinical Practice: A Review. JAMA 2024 May;331(20):1748-1760.
- Kirkley A, et al. A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. New England Journal of Medicine 2008; 359: 1097-1107.
- Moseley, JB, O’Malley, K, Petersen, NJ, et al. A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. New England Journal of Medicine2002;347:81-88.
- Koes BW, et al. Diagnosis and Treatment of Low Back Pain. British Medical Journal 2006 June;332(7555):1430-1434.
- Demay MB, et al. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism 2024 Jul 12;109(8):1907-1947.
- https://www.medscape.com/viewarticle/d-day-vitamin-d-disease-prevention-guideline-2024
