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Int J Med Inform. 2004 Feb;73(1):35-43.

A categorization and analysis of the criticisms of Evidence-Based Medicine.

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Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Mail Code: BICC, Portland, OR 97239-3098, USA.


The major criticisms and limitations of Evidence-Based Medicine (EBM) appearing in the literature over the past decade can be summarized and categorized into five recurring themes. The themes include: reliance on empiricism, narrow definition of evidence, lack of evidence of efficacy, limited usefulness for individual patients, and threats to the autonomy of the doctor/patient relationship. Analysis of EBM according to these themes leads to the conclusion that EBM can be a useful tool, but has severe drawbacks when used in isolation in the practice of individual patient care. Modern medicine must strive to balance an extremely complex set of priorities. To be an effective aid in achieving this balance, the theory and practice of EBM must expand to include new methods of study design and integration, and must adapt to the needs of both patients and the health care system in order to provide patients with the best care at the lowest cost.

[Indexed for MEDLINE]

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