In his book The Philosophy of Evidence Based Medicine, Jeremy Howick proposes a re-defining of Evidence Based Medicine from:
Evidence-based medicine requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances
to something that better clarifies the role of clinical expertise:
Evidence Based Medicine requires clinical expertise for producing and interpreting evidence, performing clinical skills, and integrating the best research evidence with patient values and circumstances.
This new characterization is carefully crafted to highlight the essential functions of clinical expertise while simultaneously de-valuing its evidential role. Why is such a change necessary? Because clinical expertise in isolation is unreliable in its ability to infer the benefit or harm of an intervention. The uncontrolled observations that contribute to clinical expertise is rife with confounders such as placebo effects, natural history and hasty generalizations. This is problematic when clinical expertise is assigned a significant evidential role when adequate comparative clinical studies are available.
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