• Ethics
• Paediatrics
• Healthcare Disparities

In recent decades, clinicians around the world have embraced the concept of evidence-based medicine. However, all too often, they are faced with situations where high-quality evidence, whether from randomised controlled trials or observational studies, is lacking. In perinatal medicine, for example, over 90% of medicines used in neonatal care and approximately three-quarters used in pregnancy have inadequate or no data on safety, efficacy and effectiveness.1 Over two-thirds of neonatal Cochrane Reviews are inconclusive because they are too small or methodologically weak,2 and the number of paediatric randomised controlled trials is falling.3

Physicians differ in their behaviours when faced with inadequate evidence. Some, in time, honoured Hippocratic tradition, believe that they must simply do as best they can for their patient. This means adopting what they consider to be the best approach, taking the patient’s individual characteristics into account and their own experience. This might be considered a form of personalised medicine, and in the absence of an alternative, a reasonable approach. But put another way, this represents the physician imposing their personal views or biases, no matter how well meant, upon their patient. The growing emphasis on shared decision-making with patients and parents is a welcome development, but does not eliminate the risk of a physician, consciously or unconsciously, framing the discussion in accord with their own views. Hence, if there are alternative approaches, these merit consideration.

Another increasingly prevalent response to …