Evidence based medicine manifesto for better healthcare: A response to systematic bias, wastage, error and fraud in research underpinning patient care.

Informed decision-making requires clinicians and patients to identify and integrate relevant evidence. But with the questionable integrity of much of today's evidence, the lack of research answering questions that matter to patients and the lack of evidence to inform shared decision-making how are they expected to do this? Too many research studies are poorly designed or executed. Too much of the resulting research evidence is withheld or disseminated piecemeal.1 As the volume of clinical research activity has grown,2 the quality of evidence has often worsened,3 which has compromised the ability of all health professionals to provide affordable, effective, high value care for patients. The BMJ and the University of Oxford's Centre for Evidence Based Medicine have collaborated on Evidence Live, a yearly conference designed to ‘develop, disseminate and implement better evidence for better healthcare’. Through this work and other projects, we know of substantial problems but also progress and solutions spanning the breadth of the evidence ecosystem, from basic research to implementation in clinical practice. The EBM manifesto offered here grew from that awareness. It is an open invitation for others to contribute to and join a movement towards better evidence by providing a roadmap for how to achieve the listed priorities and to share the lessons from achievements already made. Its aim is to complement and unite existing efforts as well as create new ones. Serious systematic bias, error and waste of medical …