Evidence-Based medicine (EBM)

“ . . the most accurate and valid evidence will relate to narrowly circumscribed questions, which may be of limited use for patient choice (W. Rogers, 98). . . . the nomination process for guidelines development reflects professional enthusiasms and existing research rather than patient identified concerns (99). . . . pharmacological interventions are those for which there is the greatest evidence. This means that non-pharmaceutical interventions such as counseling, physical therapies and life interventions, which may be of interest to patients, may be excluded from consideration because no evidence exists either for or against their effectiveness. . . . decisions about which outcomes are to be counted as benefits and burdens in reviewing existing research is a crucial part of the process, and one which traditionally has relied upon biomedical markets rather than consequences which are of importance to patients” (100) . . . . “The evidence which had the potential to enhance patient choice has been synthesized into a list of instructions, leaving the patient with the options of either accepting or refusing the guideline recommendations. . . the current practice of implementing EBM through the use of guidelines limits rather than facilitates patient choice” (101).