‘Evidence-based medicine’ is a term that is now very much in vogue. It suggests that medical practitioners move away from basing their practice on traditions and folklore and instead look to the results of carefully controlled clinical studies for guidance. This is of course good advice. But the problem is determining what makes something ‘evidence-based’. After all, even anecdotes and single events can be considered as evidence since they do provide empirical data. The key question is how to determine when there is a preponderance of evidence that gives confidence that the practice being adopted is the best among all the alternatives. The gold standard consists of carefully controlled, double-blind, reproducible tests with large sample sizes but that is not always feasible and demanding that this be the measure for determining whether a conclusion is evidence-based can be used to delay the adoption of some beneficial measure. It was demands for such unreasonably high standards of evidence that enabled tobacco companies to fight for so long the medical consensus that smoking was highly harmful to human health.
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