Do we need evidence for everything?
There is no randomized, controlled trial (RCT) supporting the contention that evidence-based medicine is beneficial, and "evidence" is more than the information that can be obtained from RCTs. Systematic reviews have severe limitations of scope and reach, and RCTs can lead to false or contradictory conclusions. Most controlled studies enroll only highly selected groups of patients, specifically excluding those with complicating factors, yet real patients bring with them an abundance of messy heterogeneity. Considering this, we should not withhold potentially beneficial treatment just because we lack randomized controlled trials. The frequent lack of solid clinical evidence requires clinicians to invoke critical thinking, communication, judgment, and even intuition on behalf of their patients. Medical training is as much an apprenticeship as it is an education, and medicine as much a craft as it is an art.
Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA. david.hunter@childrens.harvard.edu
David G
DG
Hunter
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