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March 10, 1993

Evidence-Based Medicine: A New Paradigm for the Patient-Reply

JAMA. 1993;269(10):1254. doi:10.1001/jama.1993.03500100051023

In Reply.  —We thank our correspondents for providing us with the opportunity to reemphasize several key points in our article.Dr Fox has supplied a thoughtful answer to a question that the scenario never asked. While Dr Fox raised the issue of therapy (in which the elements of net costs and benefits and patient utilities are key, as we and others have stressed elsewhere1), our scenario focused on the issue of prognosis. This emphasizes one of the important skills that evidence-based teachers must encourage: the careful definition of the question.We concur with Dr Fox's philosophical approach to practice that encourages patient empowerment. There is evidence to suggest that patients are better if they are empowered,2 though the matter warrants further study.Since several of the authors of our article previously have identified themselves as nominalists,1 readers will quickly grasp why we do not accept the narrow,