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The failure of evidence-based medicine?

Stephen Hickey, Andrew Hickey, Len Noriega


Evidence-based medicine (EBM) claims to provide gold-standard methods based on group and population statistics. However, the main issues in clinical medicine concern classification and prediction. During diagnosis, a patient’s illness is classified; then it is predicted that a specific treatment will be successful with that particular patient. Most scientific disciplines concerned with classification and prediction have rejected group and population statistics as being misleading, inadequate and inaccurate for such applications. This paper lists some of the critical findings from the decision sciences that bring the utility, application and validity of EBM into question. One of the foundations of EBM is that large clinical trials provide the best evidence. However, EBM misapplies the law of large numbers and best evidence really means selected data. EBM is inconsistent with modern science, theoretically unsound, impractical and erroneous in its application.

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