Critique of (im)pure reason: evidence-based medicine and common sense

While the goal of evidence-based medicine (EBM) is certainly laudable, it is completely based on the proposition that 'truth' can be gleaned exclusively from statistical studies. In many instances, the complexity of human physiology and pathophysiology makes this a reasonable, if not necessary, assumption. However, there are two additional large classes of medical 'events' that are not well served by this paradigm: those that are based on physically required causality, and those that are so obvious (to the casual observer) that no self-respecting study will ever be undertaken (let alone published). Frequently, cause-and-effect relationships are so evident that they fall into both categories, and are best dealt with by the judicious use of common sense. Unfortunately, the use of common sense is not encouraged in the EBM literature, as it is felt to be diametrically opposed to the very notion of EBM. As is more fully discussed in the manuscript, this active disregard for common sense leaves us at a great disadvantage in the practical practice of medicine.