[Evidence-based medicine: a movement in crisis?]

A recent paper published in The BMJ has argued that the evidence-based medicine movement is now facing a serious crisis. In the authors' opinion, the first problem is that the EBM "quality mark" has been misappropriated by vested interests. The second aspect is that the volume of evidence, especially clinical guidelines, has become unmanageable. Moreover, the statistically significant benefits may be marginal in clinical practice. Also, inflexible rules and technology driven prompts may produce care that is management driven rather than patient centred. In the end, evidence-based guidelines often map poorly to complex multimorbidity. To address the above concerns, the authors believe that a campaign for real EBM is needed: patients must demand better evidence, better presented, better explained, and applied in a more personalised way. All the relevant stakeholders (researchers, editors, publishers, etc.) should contribute to return to the movement's founding principles. The article is a detailed summary of issues already known of great interest, but perhaps with an over-emphasis in the title and tone, without focusing on the key aspect: the production and shaping of the evidence.