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Commentary
February 11, 2002

Evidence in UpheavalIncorporating Observational Data Into Clinical Practice

Arch Intern Med. 2002;162(3):249-254. doi:10.1001/archinte.162.3.249

You cannot make a pig grow by weighing him. Irish proverb1

THE EVIDENCE-BASED medicine movement has largely met with success. However, its emphasis on the randomized clinical trial may have unintentionally led to a depreciation and misunderstanding of the role of the observational study in the diagnosis, prevention, and treatment of illness in everyday clinical encounters. Published studies do modify clinical practice; no matter how rigorous, published data are only a part of the process that clinicians use to make clinical decisions. A complex system of "beliefs" guides physicians through this process. These attitudes may be modified by newer evidence, both observational and experimental, but only in association with other influential, "non–evidence-based" factors, such as personal and societal values.

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