Every prescription is a clinical trial

doi:10.1136/bmj.329.7478.1346

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Alfred P J Lake (apjlake@aol.com), consultant in anaesthesia and pain management

Glan Clwyd Hospital, Rhyl, Clwyd LL18 5UJ

EDITOR—Senn questions whether individual response to treatment is a valid assumption.1 Patients have never responded consistently to treatment, and, additionally, every time a prescription is written (except for identical twins) what effectively begins is a clinical trial with n = 1.

Evidence based medicine or evidence based clinical practice is the judicious application of best current knowledge to …