Evidence-based - Limitations and Criticism

Limitations and Criticism

Although evidence-based medicine is regarded as the gold standard of conventional clinical practice, limitations or criticisms of its use exist, such as:

• EBM produces quantitative research, especially from randomized controlled trials (RCTs). Accordingly, results may not be relevant for all treatment situations.
• RCTs are expensive, influencing research topics according to the sponsor's interests.
• There is a lag between when the RCT is conducted and when its results are published.
• Certain population segments have been historically under-researched (racial minorities and people with co-morbid diseases), and thus the RCT restricts generalizing.
• Not all evidence from an RCT is made accessible. Treatment effectiveness reported from RCTs may be different than that achieved in routine clinical practice.
• Published studies may not be representative of all studies completed on a given topic (published and unpublished) or may be unreliable due to the different study conditions and variables.
• EBM applies to groups of people but this does not preclude clinicians from using their personal experience in deciding how to treat each patient. One author advises that "the knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand" and suggests that evidence-based medicine should not discount the value of clinical experience. Another author stated that "the practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research".
• In areas where frames (contextual and presentational influences on perceptions of reality) obscure facts, hypocognition has been blamed for preventing the practical application of EBM.