With Michael Keane. Published in Trends in Anaesthesia and Critical Care (2016) 9, September, pp. 49-52.
Abstract: Is evidence based medicine the most appropriate paradigm for advancing clinical knowledge? There is increasing discussion of how evidence and science guides clinical medicine and the accumulating awareness that individualized medicine inevitably falls within a clinical gray-zone. Here we argue that the basic proposition that an analysis of historical data from controlled trials can objectively and efficiently decipher what treatments are uniformly superior is fundamentally flawed. We also argue in particular that in such a complex system as acute medicine it is predictable that randomised control trials will frequently lack the fidelity to give definitive or even useful answers, especially around the margin of progress.