Corruption of the Evidence as Threat and Opportunity for Evidence-Based Medicine

It was seventeen years ago that a set of ideas that had been evolving over the previous three decades became embodied in a unifying term: evidence-based medicine. It is impossible to think of medicine today without reference to evidence-based medicine: as of April 2007, there were 25,000 entries in MEDLINE, 1.24 million Google-identified hits on the Internet, and over 300 books on the topic in the Library of Congress catalog. The impact of evidence-based medicine extends beyond medical practice into medical education, translational research, and public health policy. For instance, the Accreditation Council for Graduate Medical Education mandates the teaching of evidence-based medicine competencies for postgraduate medical training1. Both the National Institutes of Health Roadmap Initiative2, through its translational research programs, and the U.S. Agency for Healthcare Research and Quality, through its funding of Evidence Practice Centers and other programs to promote and enhance evidence-based practice3, are examples of the influence of evidence-based medicine on the national research agenda. The World Health Organization is moving vigorously to a more evidence-based approach to its health policy guidelines, epitomized by a recent guideline concerning avian influenza4. Recently, health care opinion leaders concluded that evidence-