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Arch Hellen Med, 32(5), September-October 2015, 650-660


Clarifying the term "evidence based medicine"

T.D. Mountokalakis
National and Kapodistrian University of Athens, Medical School, Athens, Greece

Although the term evidence based medicine (EBM) is part of the everyday medical vocabulary, there is often considerable confusion over its meaning. In Greece, an additional reason for misconceptions lies in the translation of the word "evidence" into Greek words meaning either "proof" or "documentation". Instead of personal experience and pathophysiological rationale, on which medical decisions were based in the past, EBM uses evidence from clinical research, which is mainly represented by randomized control trials (RCTs), in making decisions about the care of individual patients. An updated model for evidence based clinical decision making integrates research evidence with clinical expertise and the choice of patients. Criticism of EBM covers a wide variety of topics, including shortage of scientific evidence ("gray zones"), paucity of documentation that EBM improves patient outcome, early discontinuation or non-publication, non-registration and clinical irrelevance of completed RCTs, and various limitations of the guideline process, such as lack of established working rules and conflict of interest in guideline committees. To address the above concerns, many experts call for a return to the founding principles of EBM. Despite its flaws, EBM remains an indispensable aid to clinical decision making.

Key words: Evidence, Evidence based medicine, Guidelines, Randomized controlled trials.

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