Perspective and future of evidence-based medicine

BACKGROUND: Evidence-based medicine (EBM) has evolved over a century. EBM is now the guiding principle of medical practice. High-level EBM usually derives from a well-designed, randomised, double blind, placebo controlled trial of parallel groups and sufficient number of patients enrolled. However, in recent times, concerns of EBM misguiding clinical practice have been on the rise. This paper aims at exploring the root cause of why EBM is perhaps losing its touch as the measuring standard of clinical practice. METHOD: History of EBM and criteria of determining a well-designed and conducted trial were reviewed. The impact of pharmaceutical industry on EBM has been elucidated. The percentage of clinical trials that were sponsored by the pharmaceutical industry was calculated. Some of the wrong motives of conducting clinical research were identified. RESULT: To some extent, EBM may have contributed to overdiagnose or overuse of medicine. Nearly 46% of clinical trials were financed by pharmaceutical companies. About 90% of manuscripts printed might not need to be published. Many trials contained at least one outcome that did not match its initial specification as registered. CONCLUSIONS: While EBM continues to be the guiding principle, clinicians should be aware of potential tainted results. In the future, big data is likely going to offer us a new aspect of EBM and arm us with more comprehensive data when we make our clinical decisions.