Apr 2012

Pitfalls of Evidence-Based MedicineThe Example of Actinic Keratosis Therapy

Author Affiliations

Author Affiliations: Department of Dermatology, Boston University School of Medicine J-105, Boston, Massachusetts (Dr Gilchrest); and Dermatology and Laser Center of Maui, Kihei, Hawaii (Dr Martin).

Arch Dermatol. 2012;148(4):528-530. doi:10.1001/archdermatol.2011.3042

No one can argue about the merit of evidence-based medicine. Rigorously quantifying the safety and efficacy of the medications and devices used to treat our patients allows for well-informed decisions and allocation of limited resources. This is as true for dermatology as for other medical and surgical disciplines. Evidence-based medicine promises to eliminate both intentional bias and the frequent misimpressions born of a physician's limited personal experience. The gold standard, level A evidence obtained in prospective, randomized, double-blind, placebo-controlled, properly powered trials is free of the many problems that confound interpretation of the all-too-common retrospective, nonrandomized, unblinded, and/or uncontrolled studies or reports of anecdotal experience that have made up much of the medical literature in the past. The Archives, in a manner characteristic of most first-tier clinical journals, gives strong preference to evidence-based articles and indeed requires in several categories of submissions that the level of evidence underlying specific conclusions or recommendations be explicitly detailed. Is there a problem?

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