Current Reality of EBM

I’m troubled by the current reality of EBM We have correctly learned that reason can lead us astray, so we look to evidence We have correctly learned that most evidence is actually observational and hopelessly confounded, so we look to RCTs

We have correctly learned that RCTs can be crafted, misrepresented, accused of such, hotly debated amongst respected leaders (see #CastleAF, #Orbita, #Fame, #Affirm,etc ) and often later shown to be wrong, so we look to _validated_ RCTs.

But even as this journey into EBM began, we knew the sum total of available evidence only represented a sliver of what we do. If we correctly rely on validated RCTs, we are looking at a sliver of a sliver of a sliver.

When I walk into clinic *today* I’m fully aware that validated RCT data can advise on < 5% of what I’m asked. So I go back to using reason, while robotically touting the greatness and necessity of EBM. Cognitive dissonance abounds.

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