title: [Evidence-based medicine: a new paradigm for medicine and a brand for the megastore of medicinal literature].
abstract: The current debate about the state of evidence based medicine (EBM) led to hypothesize a "crisis", claiming the need for a "renaissance" of the EBM movement. During the last two decades, EBM contributed to make medical practice more scientific, as clinical epidemiology became a science basic for clinical medicine. The traditional hierarchical structure of medicine was thwarted, and endorsing clinical decisions with the best available evidence became a moral obligation. However, although the benefits from the widespread diffusion of EBM are well known and sometimes overemphasized, the negative consequences of a mechanistic and dogmatic application of EBM cannot be ignored. For example, the need of combining scientific evidence with clinical expertise was claimed, but what's expertise not defined. Diagnostic studies are underdeveloped as compared with intervention trials. Furthermore, outcomes are mainly confined to simple accuracy measurements, and hypotheses generation, the first crucial phase of the diagnostic pathway frequently omitted. These limitations may have reduced the potential of EBM, contributing to its criticisms.
authors.forename: Luigi
authors.initials: L
authors.lastname: Pagliaro
authors.forename: Agostino
authors.initials: A
authors.lastname: Colli
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration* / Q000639:trends; D019317:Evidence-Based Medicine / Q000458:organization & administration* / Q000639:trends; D006801:Humans; D012107:Research Design