Evidence-based medicine. The good the bad and the ugly. A clinician's perspective

Evidence-based medicine (EBM) has dramatically changed clinical practice but has had its share of both supporters and detractors. From a clinical perspective, EBM has improved critical thinking, empowered young clinicians/the public and allows for the generalizing research findings to large populations. However, one of the central problems with EBM is when it is used as a cookbook approach and independent thought is sacrificed in the process. Three examples of this include the inappropriate interpretation of significance testing, understanding the role of chance and examining subgroup effects. Perhaps the most scathing criticism of EBM is the susceptibility of clinical research to abuse and fraudulent practices. Therefore, as valuable as it has been to clinical practice, the practice EBM requires that it should be critiqued itself.