[Skip to Content]
[Skip to Content Landing]
Views 267
Citations 0
Comment & Response
June 24, 2020

Evaluation of the Merits and Limitations of Evidence-Based Medicine

Author Affiliations
  • 1Department of Dermatology, Massachusetts General Hospital, Boston
  • 2Harvard Combined Dermatology Residency, Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. Published online June 24, 2020. doi:10.1001/jamadermatol.2020.1943

To the Editor Using treatments without a clear preponderance of evidence should be considered distinct from medical overuse when consensus guidelines or data-driven alternatives are lacking. In their recent systematic review, Pournamdari et al1 highlight actionable examples in which dermatologists can be more data driven in their treatment of patients, taking into account the information available about effectiveness, adverse effects, and cost. These points are well taken, but there are inherent limitations to current dermatologic research. These include the treatment of rare diseases, for which there is often less available evidence, conflicting results, or no expert consensus. Several previous studies, including 2 systematic reviews,2,3 have found cyclosporine to be safe and likely effective in the treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis in selected patients at low risk for renal failure. Although Pournamdari and colleagues highlight a study that was unable to show a benefit of cyclosporine, it may be premature to deem its utility in that disease as medical overuse on the basis of 1 single-center, retrospective cohort study that the authors acknowledge is discordant with previously published data. Multi-institution prospective trials are needed to make any definitive conclusions. In the absence of these data, the decision to discuss and offer potentially beneficial treatments is what makes medicine an art as much as it is a science.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words