Evidence-Based Medicine

To the Editor.

Regarding Dr Bauchner's comments in an article published in your journal,¹ I was struck by the author's concern that evidence-based medicine (EBM) “may be distracting from the important goal of finding ways to change physician behavior.” Dr Bauchner discussed in a nice overview the rigors of the statistical methods incorporated in the definition of EBM. The components of the EBM definition neglected, however, concerns “making decisions … about the care of individual patients.”

It has been argued that 70% of the management decisions we apply as pediatricians have not been approved for use in the pediatric age group. Therefore, practicing pediatricians have little evidence to go on. The AAP serves as a demonstrated leader in organizing consensus recommendations from the data that does exist which impacts on the pediatrician's clinical expertise in the form of clinical practice guidelines. This AAP contribution truly supports practicing medicine that is evidence-based, which I argue is not the same entity as practicing EBM. This conceptual difference was not clearly distinguished in Dr Bauchner's article. The realm of clinical expertise is not isolated to relevant information gleaned from scientific articles nor clinical practice guidelines, but also includes …