Evidence-based medicine (EBM)

This letter was published in the Br Med J (21 Feb., 2003) as a "rapid response" to a paper on disease mongering [2]. A copy of this response may be found below.

This paper was published on 03 Nov, 2010, by the British Medical Journal, as a rapid response to a News (27 Sept, 2010) on the influence of hormones on the incidence of breast cancer

Although evidence-based medicine (EBM) has been introduced 15-20 years ago as a new paradigm in order to root medical practice more deeply into scientific rationality, poor understanding of its principles often leads to a regrettable mistake: in the quest for “the best available evidence”, emphasis should be on “available” and not on “the best”.

Having missed this crucial point, most health professionals stand now their grounds in a naïve, but damaging contempt for every data which does not complies with the so-called “gold-standard” of prospective randomised controlled trials (RCTs).

However:

• a number of RCTs are simply not reliable in the way they were performed – as exemplified by the well-recognized fact that those supported by interested parties usually have more favorable issues than those supported by independent bodies;

• RCTs are not always feasible, as is quite clear with contraceptives (for ethical reasons), or with some safety issues (which would require unrealistic sample sizes);

• those who have the regulatory or financial responsibility for performing RCTs, (or, at least: investigations complying with a minimum of standards) may be reluctant to do so, as they may have good reasons to be anxious about the results.

In 1989, Prozac, became available in French pharmacies. The "happy pill" was first seen as a sort of cultural phenomenon before being criticized. Twenty years after, has Prozac proved to be efficient or is it just another drug?

This letter was published in the Br Med J (8 Sept, 2000) as a "rapid response" to a paper [4] on homoeopathy.