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Editorials: POINT/COUNTERPOINT EDITORIALS |

Counterpoint: Evidence-Based Medicine Lacks a Sound Scientific Base

Martin J. Tobin, MD
Author and Funding Information

Hines, IL

Correspondence to: Martin J. Tobin, MD, Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine, Edward J. Hines, Jr, Veterans Administration Hospital, Fifth Ave and Roosevelt Road (111N), Hines, IL 60141; e-mail: mtobin2@lumc.edu



Chest. 2008;133(5):1071-1074. doi:10.1378/chest.08-0077
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Extract

I firmly believe clinical practice should be based on the best scientific evidence. But how do you define best evidence? Evidence-based medicine (EBM) founders say “identifying the best evidence means using epidemiologic and biostatistical ways of thinking.”1Table 1 lists five reasons why this approach is scientifically unsound.

1Davidoff, F, Haynes, B, Sackett, D, et al (1995) Evidence based medicine.BMJ310,1085-10862Cook, DJ, Guyatt, GH, Laupacis, A, et al Clinical recommendations using levels of evidence for antithrombotic agents.Chest1995;108(4 Suppl),227S-230S3Sackett, DL, Straus, SE, Richardson, WS, et al Evidence-based medicine: how to practice and teach EBM 2nd ed.2000,108 Churchill Livingstone. Edinburgh, UK: 4Evidence-Based Medicine Working Group.. Evidence-based medicine: a new approach to teaching the practice of medicine.JAMA1992;268,2420-24255Linde, K, Clausius, N, Ramirez, G, et al Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials.Lancet1997;350,834-8436Tobin, MJ, Jubran, A Meta-analysis under the spotlight: focused on a meta-analysis of ventilator weaning.Crit Care Med2008;36,1-77Haack, S Defending science–within reason: between scientism and cynicism2007 Prometheus Books. New York, NY: 8Popper, K The logic of scientific discovery1958 Hutchison. London, UK: 9GRADE Working Group.. Grading quality of evidence and strength of recommendations.BMJ2004;328,1490-149410Ziman, J Real science: what it is, and what it means2000 Cambridge University Press. Cambridge, UK: 11Haynes, B What kind of evidence is it that evidence-based medicine advocates want health care providers and consumers to pay attention to?BMC Health Serv Res2002;2,1-712Guyatt, GH, Sackett, DL, Sinclair, JC, et al Users' guides to the medical literature: ix. A method for grading health care recommendations; Evidence-Based Medicine Working Group.JAMA1995;274,1800-180413Ely, EW, Meade, MO, Haponik, EF, et al Mechanical ventilator weaning protocols driven by nonphysician health-care professionals: evidence-based clinical practice guidelines.Chest2001;120(6 Suppl),454S-463S14Ely, EW, Baker, AM, Dunagan, DP, et al Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously.N Engl J Med1996;335,1864-186915Pitt, B, Zannad, F, Remme, WJ, et al The effect of spironolactone on morbidity and mortality in patients with severe heart failure: randomized Aldactone Evaluation Study Investigators.N Engl J Med1999;341,709-71716Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee To Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult, executive summary.Circulation2001;104,2996-300717Juurlink, DN, Mamdani, MM, Lee, DS, et al Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study.N Engl J Med2004;351,543-55118Sinuff, T, Cook, DJ, Randall, J, Allen, CJ Evaluation of a practice guideline for noninvasive positive-pressure ventilation for acute respiratory failure.Chest2003;123,2062-207319Hill, NS Practice guidelines for noninvasive positive-pressure ventilation: help or hindrance?Chest2003;123,1784-178620Straus, SE, McAlister, FA Evidence-based medicine: a commentary on common criticisms.Can Med Assoc J2000;163,837-841

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