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Short Reports

Seven alternatives to evidence based medicine

BMJ 1999; 319 doi: (Published 18 December 1999) Cite this as: BMJ 1999;319:1618
  1. David Isaacs, clinical professor (,
  2. Dominic Fitzgerald, staff physician
  1. Departments of Education and Medicine, New Children's Hospital, Westmead, NSW 2145, Australia
  1. Correspondence to: D Isaacs

    Clinical decisions should, as far as possible, be evidence based. So runs the current clinical dogma. 1 2 We are urged to lump all the relevant randomised controlled trials into one giant meta-analysis and come out with a combined odds ratio for all decisions. Physicians, surgeons, nurses are doing it35; soon even the lawyers will be using evidence based practice.6 But what if there is no evidence on which to base a clinical decision?

    Participants, methods, and results

    We, two humble clinicians ever ready for advice and guidance, asked our colleagues what they would …

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