Evidence based practice in leprosy: where do we stand?

Since the 1990s, the concept of ‘evidence based medicine’ (EBM) has received growing interest. Its main rationale was the recognition that systematic synthesis of evidence from high quality clinical research should be guiding clinical practice. Important developments in EBM included the introduction of structured abstracts and of systematic reviews. Nowadays, EBM can be described as ‘healthcare practice that is based on integrating knowledge gained from the best available research evidence, clinical expertise, and patients’ values and circumstances’. While results from randomised controlled trials (RCTs), and especially the systematic review of several RCTs, are often considered as ‘best evidence’, RCTs are not suitable for all types of clinical questions, such as assessing the accuracy of diagnostic tests or the impact of prognostic factors. Evidence based medicine should therefore not be limited to RCTs and meta-analyses. Its main goal is to guide clinical decision making that is based on the best available evidence. Whether EBM has made a difference in the past decade was discussed in a special theme issue of the British Medical Journal (October 30, 2004). EBM has made a difference in contributing to the discussion and development of systematically collecting and summarising evidence of clinical research. EBM has not only created enthusiasm, but has also received criticism. For example, critics opposed the idea that EBM would restrict choices in terms of promoting a single ‘right’ way to practice, would declare RCTs as the only type of study to be useful, or would be driven by costs and cost savings. One of the big challenges for EBM in the coming years will be to implement clinical evidence into clinical practice. EBM should not only produce best available evidence, but should also find effective ways for implementation and to make this evidence accessible to clinicians, consumers, policy makers, and other stakeholders.