Is there life after evidence-based medicine?

Recent years have witnessed the rising star of evidence-based medicine (EBM) as an approach towards rationalizing clinical practice in the face of an exponentially growing body of knowledge. Along with it, however, a sense of unease is rising among practising doctors, as they feel that well-intentioned principles may be increasingly applied to disease management, with its economic and cost-cutting implications, rather than disease cure or treatment. There is a fear that any procedure, however time-honoured, that was not or cannot be subjected to randomized controlled clinical trial, may some day be discouraged, more or less strongly, based on statistical rather than clinical considerations. Resistance to EBM ranges from a 'we-know-best' uncompromising non-acceptance to a 'you-may-be-right-sometimes-but-don't-ever-tell-me-what-to-do' sort of openness. The problem is one of measure, in more than one sense: measure of how effective individual practitioners are in treating their patients, measure of how useful EBM is, measure in promoting what may become a dogmatic application of probability laws to the very improbable practice of medicine, measure in siding with the supporters of health care on a budget. There is much that EBM can give to clinical medicine by its ability to organize complex data sets for the ultimate benefit of patients, but there is also much that can stifle practice by forcing a dogmatic implementation, rather than a flexible common sense approach, of its principles.