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Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices

Vinay Prasad and John PA Ioannidis*

Author Affiliations

National Cancer Institute, Bethesda, MD (VP) and Stanford Prevention Research Center, Departments of Medicine and Health Research and Policy, Stanford University School of Medicine, and Meta-Research Innovation Center at Stanford (METRICS), Medical School Office Building, Room X306, Stanford, CA 94305, USA

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Implementation Science 2014, 9:1  doi:10.1186/1748-5908-9-1

Published: 8 January 2014


Abandoning ineffective medical practices and mitigating the risks of untested practices are important for improving patient health and containing healthcare costs. Historically, this process has relied on the evidence base, societal values, cultural tensions, and political sway, but not necessarily in that order. We propose a conceptual framework to guide and prioritize this process, shifting emphasis toward the principles of evidence-based medicine, acknowledging that evidence may still be misinterpreted or distorted by recalcitrant proponents of entrenched practices and other biases.

Evidence-based medicine; Reversals; Divestment; De-implementation; Contradiction; Bias