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Book and Media Reviews
December 5, 2007

Evidence-Based Neurology: Management of Neurological Disorders

Author Affiliations

Book and Media Reviews Section Editor: John L. Zeller, MD, PhD, Contributing Editor.

JAMA. 2007;298(21):2546-2552. doi:10.1001/jama.298.21.2549

Evidence-based medicine (EBM) in some settings leads to polarized debate between proponents and detractors, akin to discussions of gun control or health care reform. Nevertheless, several experienced investigators have raised legitimate concerns about the foundations and applications of EBM as it has been promulgated. Caplan, for example, has noted that the phrase “evidence based”

has become a shibboleth, a sacrosanct icon almost like motherhood. Who could possibly be against basing decisions on evidence? . . . The almost religious zeal for cloaking all decisions under the banner of evidence based conceals the real problem—that is, what is the evidence? . . . (1) trials and meta-analyses have important limitations which make it unlikely that they will become the basis for most daily bedside medical decisions; and (2) whether a treatment is “evidence based” depends both on the quality of the evidence and the clinical context in which the evidence is applied.1

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