Is Modern Medicine Evidence Based?
Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices
Contradicted established medical practices
The number of medical practices where the best evidence shows no efficacy or harms outweighing benefits is substantial. One search produced over 150 potentially ineffective or unsafe practices , and empirical reviews of high impact medical journals have generated over 140 reversed medical practices .
When large, well-done randomized trials have contradicted current medical practice, de-implementation makes sense, but it can meet with fierce tactical resistance. Proponents of contradicted medical practices can procure not only editorials, but also counter-evidence that cuts corners, e.g. focusing on lesser endpoints, highlighting subgroup analyses, or performing additional studies with straw man controls. Expert-based meta-analyses with tailored eligibility criteria and outcome selection to show some benefit , and conflicted expert guidelines can follow suit .