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LETTERS: Benjamin Druss Evidence based medicine: does it make a difference?: Use wisely BMJ 2005; 330: 92 [Full text]

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Evidence Based Mythology

Iain F Brew   (8 January 2005)

Evidence Based Mythology 8 January 2005
Iain F Brew, Prison Medical Officer HM Prison Lincoln UK, LN2 4BD Send response to journal: Re: Evidence Based Mythology	It is very refreshing to hear Druss describing the judicious use of evidence based medicine. How many colleagues have been won over without scepticism by "EBM"? I find myself sitting in postgraduate meetings on a regular basis needing to pinch myself to remember that absence of evidence should not be confused with evidence of absence of cause or effect. Too many tried and tested treatments used by our predecessors have been abandoned due to a lack of perceived evidence, only to be reintroduced later once a study has been published. A recent example might be the use of carbocysteine, which has now been in and out of vogue twice during my 15 year career. Another important string to the argument against blind use of EBM is the fact that randomised double-blind placebo-controlled trials (the gold standard in modern research)only give information about population responses to the treatment in question. We still do not have reliable indicators of expected response to treatments in individuals. By all means encourage the intelligent use of EBM, but let it be with a critical eye. Competing interests: None declared