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Welcome to Rationally Speaking, the podcast where we explore the borderlands between reason and nonsense.

I'm your host, Julia Galef, and with me is today's guest, Dr. Vinae Prasad.

Vani is a hematologist, oncologist, and an assistant professor of medicine at the Oregon Health and Sciences University.

He's also the co-author, along with Dr. Adam Seifu,

of the book Ending Medical Reversal, Improving Outcomes, Saving Lives.

The book treats the question of why is it so often the case

that an established consensus in the field of medicine

about how to treat a certain condition or certain

disease gets overturned after many years of being in use when a rigorous study shows that it has

no effect or is even in some cases harmful. So why does that happen and what can we do about it? And that's

what we're going to be talking about on today's episode. Welcome to the show,

Vinay. Thanks so much for having me. So just to give our listeners a sense of what a medical

reversal looks like, could you give an example or two of some of the big reversals in recent years?

Sure. So let me first put it a little bit in context. So I think, you know, myself and maybe

many of the listeners, I think, you know, the way we sort of initially conceptualized medicine was,

you know, the sort of thing where for many years, doctors do something, and it's pretty good.

It's a treatment that works. And then something comes along, a breakthrough, a discovery,

and we come up with a new treatment that actually works even better. And so I think many of us

have this idea that medicine is a series of what we call replacement. Something better comes along.

But I think Adam and I had been noticing over the years sort of a disconcerting pattern that a bunch

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