Karanicolas et al,1 however, fails to mention that EBM “is about integrating individual clinical expertise and the best external evidence.”4 Expertise is needed to understand the clinical problems, to formulate hypotheses, to search and appraise the evidence (avoiding the methodologic traps highlighted by Tobin2), to chose the best options, and apply them in practice. Without expertise, EBM becomes “cookbook medicine,” something that explicitly it is not intended to be.4 Expertise varies, and there are better and poorer practitioners, as well as studies, systematic reviews, and guidelines. Tobin2 provides only anecdotal evidence of the fact that meta-analyses can be flawed, and he might be comforted to know that he was not the first one.7 But as finding a single black swan is sufficient to falsify the assertion that all swans are white, his point is made that not all systematic reviews are perfect. Of course, these may be examples of evidence being replaced with a better one, or of what Popper3 describes as the common, unintended effects of any rational human activity which need to be dealt with using “piecemeal engineering.” But again, this requires expertise and critical thinking. So, if Tobin's remarks come as a reminder that the use of clinical evidence must be “conscientious, explicit, and judicious,”4 and that the critical application of any source of information (be it dogmatic or empirical), including randomized controlled trials, meta-analyses, systematic reviews, checklists, and guidelines, is likely to cause more harm than good, then in our opinion his contribution should be most welcome and might be highly beneficial to the practice of EBM.