Acupuncure in Medicine Vol 17 (1)

Evidence based medicine Evidence-based medicine relies mainly on the findings from clinical trials, and to minimise selection bias such trials should ideally be randomised. As the results of clinical studies are rarely identical, the fairest judgement on the effectiveness of a therapeutic intervention is generated through systematic review of clinical trials. Systematic reviews have to demonstrate that all the available evidence that fulfils appropriate criteria has been considered. Once systematic reviews have established the current evidence on a given subject, this knowledge needs to be implemented in clinical practice. In a nutshell, these are the principles of evidencebased medicine (EBM) (1). For evaluating treatment modalities, EBM does not rely on criteria such as plausibility of mechanisms of action nor is it dominated by the opinions or experiences of experts in a given field of therapeutics. EBM relies mainly on the results of rigorous clinical investigation and analysis. This is perhaps best illustrated through the hierarchy of evidence which can be viewed as the backbone of EBM (Figure 1).