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This is the title of a talk Professor David Healy gave in November 2012 at the Cardiff University.1 I came across it by chance, while surfing on the internet and reading the comments posted on the BMJ forum, Doc2Doc.2 While watching the video, it was a bit of a surprise to me to see a network meta-analysis on antidepressants I published in the Lancet in 2009, quoted to show how much evidence is biased in favour of pharmaceutical companies. The bottom line of the talk was: as we do not have access to all study data and most of randomised controlled trials are flawed or misconducted, conclusions from systematic reviews and meta-analyses—even when carried out by researchers from independent institutions—are misleading. Clinicians should better rely on their experience and not follow evidence-based clinical guidelines. This is what I understood from this speech and is likely to be what others will have grasped as a take-home message.
An evidence-based decision about a specific intervention (either pharmacological or not) is not determined only by its demonstrated efficacy and tolerability3; it may vary from one patient to another depending on individual clinical circumstances (sex, age, clinical history, etc) and personal preferences.4 However, as David Healey points out, ‘evidence’ is not necessarily ‘evident’. Evidence is anything presented in support of an assertion. This support may be strong or weak, but it is the closest that we can get to the truth itself and the only objective starting point we can use for our clinical reasoning. We need some data, if available, to justify our rational choice; otherwise patients will be treated according to mere opinion. This is the reason why I strongly disagree with opponents of Evidence Based Medicine (EBM) who say that it is the wrong paradigm to …
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