Leading article
Evidence based medicine
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Traditionally the physician's absolute right to decide
what treatment any individual patient should be offered has been the Holy Grail of clinical practice since the earliest of time. Such a
decision has clearly always been influenced by individual physician experience, and the presented or published results of fellow
practitioners. The first medical research trials to investigate the use
of patulin treatment in the common cold 1943-44 (double blind
controlled trial with quasi randomisation)1 and of
streptomycin in tuberculosis 1947-48 (randomised control trial but
with no placebo)2 heralded in a new era. Bradford Hill is
reported to have been worried "that doctors would be unwilling to
relinquish the doctrine of anecdotal experience" when he proposed the
concept of randomised clinical trials.3 4 The randomised
clinical trial has become the "gold standard" by which the choice
of treatment and evidence to support its use is now judged. The
physician inevitably must ultimately decide,
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