Is Evidence Based Medicine the definite proof?
The major criticisms and limitations of Evidence-Based Medicine (EBM)
appearing in the literature over the past decade can be summarized and catego-
rized into five recurring themes. The themes include: reliance on empiricism, narrow definition of evidence, lack of evidence of efficacy, limited usefulness for individual patients, and threats to the autonomy of the doctor/patient relationship. Analysis of EBM according to these themes leads to the conclusion that EBM can be a useful tool, but has severe drawbacks when used in isolation in the practice of individual patient care. Modern medicine must strive to balance an extremely complex set of priorities.
To be an effective aid in achieving this balance, the theory and practice of EBM must expand to include new methods of study design and integration, and must adapt to the needs of both patients and the health care system in order to provide patients with the best care at the lowest cost.
© 2003 Elsevier Ireland Ltd. All rights reserved.
appearing in the literature over the past decade can be summarized and catego-
rized into five recurring themes. The themes include: reliance on empiricism, narrow definition of evidence, lack of evidence of efficacy, limited usefulness for individual patients, and threats to the autonomy of the doctor/patient relationship. Analysis of EBM according to these themes leads to the conclusion that EBM can be a useful tool, but has severe drawbacks when used in isolation in the practice of individual patient care. Modern medicine must strive to balance an extremely complex set of priorities.
To be an effective aid in achieving this balance, the theory and practice of EBM must expand to include new methods of study design and integration, and must adapt to the needs of both patients and the health care system in order to provide patients with the best care at the lowest cost.
© 2003 Elsevier Ireland Ltd. All rights reserved.
"Randomised controlled trials (RCTs), long regarded at the 'gold standard' of evidence, have been put on an undeserved pedestal. Their appearance at the top of "hierarchies" of evidence is inappropriate; and hierarchies, themselves, are illusory tools for assessing evidence. They should be replaced by a diversity of approaches that involve analysing the totality of the evidence-base."
Professor Sir Michael Rawlins, Chair of the National Institute for Health and Clinical Excellence at the 2008 Harveian Oration
Professor Sir Michael Rawlins, Chair of the National Institute for Health and Clinical Excellence at the 2008 Harveian Oration