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Evidence-based medicine as a movement has faced much recent criticism.1 This criticism has taken many forms. Perhaps most seriously, it has come under attack from practising healthcare professionals and patients. At the core of many criticisms is the feeling that evidence-based medicine has become disengaged from real-world clinical practice. There may be valid reasons for this perspective. Trials often include people with single illnesses, and yet increasingly with an aging population, people have multiple morbidities. Evidence-based medicine encourages following defined care pathways.2 However, patients might not fit well with these pathways, and might not want to follow them.
Evidence-based medicine continues to produce a tidal wave of information. Yet the practising clinician wants a quick and accessible answer to an individual question—and all too often cannot get this. In addition, trials that find statistically significant outcomes can have little clinical importance or applicability. Evidence-based medicine as a movement has only been in existence for about 20 years. With all this criticism it is tempting to ask—is it already on the way out? Does it really have a future at all? Evidence-based medicine certainly does have a future, but it will have to evolve if it is going to be useful and relevant. It will have to address issues such as multiple morbidity; it will have to provide accessible answers; and it will have to deal in clinically important and patient-relevant outcomes as well as statistically significant ones.
Firstly, evidence-based medicine will have to more explicitly address multiple morbidity and the individual context of decision-making.3 This is perhaps its greatest challenge. Two …