title: Taking stock of evidence-based medicine: opportunities for its continuing evolution.
abstract: Tough but constructive criticisms of evidence-based medicine (EBM) have without doubt informed the evolution and serial reconstitutions of this approach to clinical decision making and behaviour. Yet, concerns about EBM persist and as EBM changes in response to reflection and criticism, so too do the criticisms themselves. This paper describes our current understanding of EBM and, to identify opportunities for the continuing evolution of EBM, discusses some key attributes of EBM that still or now cause us concern. Specifically, these attributes are the nature of evidence in EBM; the unknown effectiveness of EBM; the clinician-centric focus of EBM; and the potential of EBM to harm patients.
authors.affiliation: Department of General Practice and Primary Health Care, University of Auckland, Private Bag, Auckland, New Zealand. s.buetow@auckland.ac.nz
authors.forename: Stephen
authors.initials: S
authors.lastname: Buetow
authors.forename: Ross
authors.initials: R
authors.lastname: Upshur
authors.forename: Andrew
authors.initials: A
authors.lastname: Miles
authors.forename: Michael
authors.initials: M
authors.lastname: Loughlin
mesh_terms: D003657:Decision Making; D034462:Dissent and Disputes; D036262:Empirical Research; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards*; D006801:Humans; D018802:Patient-Centered Care; D010506:Periodicals as Topic; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome