The Limits of Evidence Based Medicine

The term “evidence-based medicine” was originally used to describe the broad scientific and experiential underpinnings of medical practice, as opposed to personally held views, limited personal experience, or “how I was taught.” Unfortunately, it has become a faddish term to describe the focus on randomized trials and meta-analyses as the primary drivers of medical practice. The term is now used to limit access to care and to try to develop menu-like algorithms for treatment of complicated patients. Data from clinical trials is filled with artifacts and design flaws that go un-criticized. The field is now plagued more and more by errors in selection because of increased emphasis on reliability with decreased emphasis on validity. The need for true expert input on research and design is obvious from a review of these problems.