Evidence-based common sense?

Like most physicians, I try to keep up to date on my journal reading and continuing medical education conference participation in an effort to provide the best possible care to my patients and community, in accordance with the most evidence-based practice of the time. Of course, this requires me to accept an assumption that the evidence-based research that such journal articles and conference presentations are based upon is valid and an effective and appropriate means of elucidating the benefits and drawbacks of various clinical interventions. Evidence-based medicine (EBM) is the popular term, all too loosely used, to validate claims made by various health practitioners, educators, authors, researchers, and pharmaceutical company representatives about the benefits and limitations of drug use and clinical management of disease. According to Marchevsky’s Critical Appraisal of Medical Literature, EBM aims to “de-emphasize intuition, unsystematic clinical experience, and pathophysiological rationale as sufficient grounds for clinical decision making.”1 Certainly, if all research were truly randomized, blinded, and free from any bias, then such a rigorous, scientific approach might offer a reliable source of clinical advancement. The reality, however, is that bias, competing interests, and misinterpretation (or manipulation) of data are all rampant in our medical literature and continuing medical education. It is thus the important responsibility of the clinician reader to interpret such medical literature with a discerning eye, a healthy scepticism, and both feet firmly grounded in their own common-sense intelligence. That’s right, I said it—common sense. Perhaps our faith in EBM as the “end-all, be-all” authority on best practice is so absolute and exclusive that it blinds us from our own experience and intelligence.