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January 1, 2003
Evidence-Based Medicine

Many physicians feel pressure to limit their prescribing to therapies that have been shown to be effective using the current standard of a "randomized clinical trial". A problem exists when a patient does not respond to traditional therapy, and therefore still has a need for an effective treatment. This patient's medical problem might be solved by using a customized therapy that is based upon sound scientific reasoning and/or a single study of one successful case
("n=1 trial"). J.R. Hampton, a physician at University Hospital in Nottingham, UK eloquently addresses this issue in an article which appeared in Perspectives in Biology and Medicine in Autumn 2002.

"The freedom of a doctor to treat an individual patient in the way he believes best has been markedly limited by the concept of evidence-based medicine. Clearly all would wish to practice according to the best available evidence, but it has become accepted that "evidence-based" means that which is derived from randomized, and preferably double-blind, clinical trials. The history of clinical trial development, which can be traced to the use of oranges and lemons for the treatment of scurvy in 1747, has... led to difficult concepts such as "equivalence" and aberrations such as "meta-analysis." An examination of evidence-based
practice shows that it has usually been filtered through the opinions of experts and journal editors, and "opinion-based medicine" would be a more appropriate term. In the real world of individual patients with multiple diseases who are receiving a number of different drugs, the practice of evidence-based (or even opinion-based) medicine is extremely difficult. For each patient a judgment has to be made by the clinician of the likely balance of risks and benefits of any therapy. Good practice still requires clinical freedom for doctors."

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