| Author | Claim | RCT | Clinical outcome of medical practice | Trial outcome | Magnitude of benefit/outcome met in trial |
|---|---|---|---|---|---|
| Falchook,12 2015 | Nivolumab for metastatic melanoma has so impressive a response rate and progression-free survival that, akin to a parachute, examining overall survival is not necessary | Nivolumab versus chemotherapy in patients with advanced melanoma who progressed after anti-CTLA-4 treatment (CheckMate 037): a randomised, controlled, open-label, phase 3 trial13 [nivolumab was superior to decarbazine in CheckMate 6614 (and choice of comparator seemed a straw man, given year trial was performed)] | Reduction in mortality | Supported practice | 1-yr overall survival rate increased from 42.1% to 72.9%; ARR 30.8%, NNT 3 |
| Schaan et al.,15 2015 | Insulin analogues are superior to regular human insulin for achieving glycemic control in type 1 diabetes | Several, including large meta-analyses such as Systematic review and meta-analysis of short-acting insulin analogues in patients with diabetes mellitus16 and Long-acting insulin analogues vs. NPH human insulin in type 1 diabetes. A meta-analysis17 | Reduction in diabetes-related events (cardiovascular/renal/ocular/neurologic) | Mixed | - |
| Montresor et al.,18 2015 | Empirical deworming therapy of children in endemic areas has clinical benefit | Cochrane reviews of multiple RCTs, including Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin, and school performance19 | Clearance of parasites | Refuted claim | - |
| Luft et al.,20 2014 | Stenting for renal artery stenosis benefits some patients so greatly that it is a parachute | Stenting and medical therapy for atherosclerotic renal-artery stenosis21 | Reduction in cardiovascular events | Refuted claim | - |
| White,22 2011 | Stenting for renal artery stenosis benefits some patients so greatly that it is a parachute | Stenting and medical therapy for atherosclerotic renal-artery stenosis21 | Reduction in cardiovascular events | Refuted claim | - |
| Bender et al.,23 2015 | Simulation-based training for medical personnel obviously improves patient outcomes in critical care medicine | Multiple, including Simulation improves procedural protocol adherence during central venous catheter placement: a randomized controlled trial24 | Reduction in mortality | Mixed | - |
| Lighthall et al.,25 2007 | Simulation-based training for medical personnel obviously improves patient outcomes in critical care medicine | Multiple, including Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial26 | Reduction in mortality | Mixed | - |
| Cefalu et al.,27 2015 | Recognition and treatment of prediabetes leads to improved patient outcomes | Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin28 | Reduction in diabetes-related events (cardiovascular/renal/ocular/neurologic) | Supported practice | Cumulative incidence of diabetes at 3 yr decreased from 28.9% to 14.4%; ARR 14%, NNT 7 |
| Scheen et al.,29 2014 | Treating diabetes with agents that lower blood glucose will invariably lead to improved cardiovascular outcomes | Action to Control Cardiovascular Risk in Diabetes,30 UK Prospective Diabetes Study,31 Veterans Affairs Diabetes Trial32 | Reduction in cardiovascular events | Refuted claim | - |
| Gleicher et al.,33 2016 | Most of current in vitro fertilization use and application is so obviously beneficial at conceiving children it does not require randomized trials | A multicentre randomized controlled trial of expectant management versus IVF in women with fallopian tube patency34 | Increased rates of live birth | Supported practice | Live birth rate improved from 1% to 29%, ARR 28%, NNT 3 |
| Bush,35 2008 | The use of pancreatic enzyme replacement for patients with cystic fibrosis and pancreatic insufficiency has clear clinical benefit | Efficacy and safety of Pancreaze® for treatment of exocrine pancreatic insufficiency due to cystic fibrosis36 | Weight gain/absorption/nutrition | Supported practice | Measures of fat absorption improved, but ARR and NNT could not be calculated |
| Mattei,37 2013 | Intracranial pressure monitoring for severe traumatic brain injury provides useful information that improves outcomes | A trial of intracranial-pressure monitoring in traumatic brain injury38 | Reduction in mortality | Refuted claim | - |
| Eljamel,39 2010 | Photodynamic therapy improves outcomes in glioblastoma multiform | ALA and malignant glioma: fluorescence-guided resection and photodynamic treatment40 | Reduction in mortality | Supported practice | Progression-free survival at 6 mo increased from 21% to 41%; ARR 20%, NNT 5 |
| Primrose et al.,41 2010 | Metastasectomy improves outcomes in pulmonary colorectal cancer | Pulmonary metastasectomy in colorectal cancer: the PulMiCC trial42 | Reduction in mortality | Ongoing | - |
| Schellinger et al.,43 2006 | Intra-arterial thrombolysis improves clinical outcomes in acute basilar artery thrombosis | Results of a multicentre, randomised controlled trial of intra-arterial urokinase in the treatment of acute posterior circulation ischaemic stroke44 | Reduction in mortality | Halted (low recruitment) | - |
| Hofman et al.,45 2014 | Peptide receptor radionuclide therapy for neuroendocrine tumours is of clear benefit | NETTER-1 phase III in patients with midgut neuroendocrine tumors treated with 177Lu-DOTATATE: efficacy and safety results46 | Reduction in mortality | Supported practice | Overall mortality rate decreased from 23% to 12%; ARR 11%, NNT 9 |
| Friedman et al.,47 2006 | Hyperbaric oxygen therapy improves skin graft healing and survival | Influence of hyperbaric oxygen on the survival of split skin grafts,48 Changes in arterial flow after flap grafting under various tensions49 | Rates of skin graft rejection | Mixed | - |
| Yehai,50 2006 | Use of ultrasonographic guidance during embryo transfer in in vitro fertilization is obviously beneficial | Ultrasound-guided embryo transfer: a prospective randomized controlled trial51 | Increased rates of live birth | Mixed | - |
| Baca et al.,52 2011 | The benefit of hyperthermic intraperitoneal chemotherapy in peritoneal mesothelioma is so obvious that it is akin to a parachute | Surgery plus intraoperative peritoneal hyperthermic chemotherapy (IPHC) to treat peritoneal carcinomatosis53 | Reduction in mortality | Completed, no results published | - |
| McCullough, 201454 | The use of sucralfate for oral mucositis is of such great benefit that it should be considered level 1A evidence based on observational studies | Magic mouthwash plus sucralfate versus benzydamine hydrochloride for the treatment of radiation-induced mucositis55 | Decreased mucositis pain/discomfort | Ongoing | - |
| Sharif et al.,56 2010 | Repair of defective dental restorations with composite restoration should be considered over replacement strategies, despite lack of RCT data | Study of the success and survival of dental composite restorations being repaired instead of being replaced57 | Dental outcomes | Halted (low recruitment) | - |
| Cannon et al.,58 2005 | Use of hygiene education interventions for the prevention of cytomegalovirus transmission is beneficial, akin to a parachute | Clinical trial of behavioural modification to prevent congenital cytomegalovirus59 | Reduced infection transmission | Completed, no results published | - |
Note: ALA = 5-aminolevulinic acid, ARR = absolute risk reduction, IVF = in vitro fertilization, NNT = number needed to treat, NPH = neutral protamine Hagedorn, RCT = randomized controlled trial.