Letters Crisis in evidence based medicine

Evidence based medicine needs to be more pragmatic

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4453 (Published 09 July 2014) Cite this as: BMJ 2014;349:g4453
  1. David Oliver, consultant geriatrician and general physician1
  1. 1Royal Berkshire Hospital, Reading RG1 5AN, UK
  1. d.oliver{at}kingsfund.org.uk

I agree with Greenhalgh and colleagues that evidence based medicine works best for single diseases and not for patients with complex comorbidity, frailty, and dementia.1 But such patients are now the “core business” of health services. Their exclusion from clinical trials, with research funding mainly allocated to younger people with single diseases, means that much of the …

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