Intended for healthcare professionals


Does evidence based medicine do more good than harm?

BMJ 2004; 329 doi: (Published 28 October 2004) Cite this as: BMJ 2004;329:1051
  1. M G Myriam Hunink, professor of clinical epidemiology and radiology (
  1. Erasmus MC, Rotterdam, The Netherlands

    Advocates of evidence based medicine (EBM) have unleashed a huge move towards asking explicit questions, critical appraisal of the literature, finding and applying the best available evidence, and a rigorous quantitative approach to medicine. But does EBM do more good than harm?

    If we argue that medicine needs to be evidence based, then logically we need evidence to support EBM. I have yet to find that evidence. It would be impossible to design a randomised study evaluating the cost effectiveness of EBM that would fulfil the criteria for qualifying as “evidence,” because of the contamination that occurs from one case (doctor) to the next and because the sample size would need to be enormous. Probably the only feasible study would be to measure the costs and (subjectively experienced) usefulness of different forms of continuing education that use an EBM approach and to compare them with a regular approach.

    Do we even need evidence that evidence based medicine works?

    Do we even need evidence that EBM works? Some people say that the …

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