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Dear Piersante, I agree that the problem is about how EBM is defined, but I think there is more at stake between the two parties than 'rule based' and 'heuristic based' EBM. Your heuristic-based EBM defines a community of practitioners that use evidence in sophisticated ways to benefit their patients. I take it your definition is close to what most EBM practitioners hold. Heuristic-EBM gains the benefit of permitting a sophisticated take on medical evidence and decisions at the expense of not being explicit about how evidence should be applied to decisions. And this goes against part of what EBM is usually taken to be (especially in the guidebooks and early papers, but it is often alluded to in some way in discussions of EBM). The rule-based EBM has the benefit of being clear about how to make decisions, it is more clearly different from medical decision-making prior to EBM, and it is easier to teach and disseminate. But it is inadequate for medical decisions. Both you and your critics reject rule-based EBM, the disagreement appears to be what you want to call what remains. Kind Regards Adam Adam La Caze Lecturer School of Pharmacy The University of Queensland