Postulates of evidence-based medicine have transformed into myths

Abstract

“Evidence-based medicine” (EBM) proposes methods, techniques, and instruments for verifying, incorporating, and applying scientific information in individual and public health. However, the principles and postulates of EBM have evolved over time. Our objective was to analyze the principles and postulates of EBM and compare them with current research, to identify possible myths. We conducted a review and analysis of the literature to identify the current principles of EBM and its most disseminated postulates. Subsequently, we compared these postulates with scientific evidence and EBM principles to identify potential myths. We identified 3 current principles of EBM: “EBM is a systematic summary of the best available evidence”, “EBM provides guidance to determine the level of confidence in estimates”, and “Evidence is never enough to drive clinical decision making.” Additionally, we identified 4 widely disseminated postulates: (1) Systematic reviews are at the top of the evidence pyramid, (2) randomized clinical trials are the best type of evidence, (3) expert opinion is a type of scientific evidence, and (4) to make health decisions, we should only use scientific publications. We critically assessed these postulates against scientific evidence and EBM principles, revealing them to be "myths." We identified f4 myths of EBM and proposed solutions to foster a more accurate interpretation and utilization of scientific evidence.