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In my view Evidence Based Practice (EBP) takes into account both the available empirical evidence and also the contextual evidence relating to the particular case (that person at that point in time) including patient characteristics, comorbidities, patient & practitioner values, ethical, legal, policy, resource constraints, relative risks given to various benefits and harms of intervening or not intervening. In combination this leads to (hopefully shared) clinical decision-making. We need to consider both types of evidence - it is not either/or. See http://fampra.oxfordjournals.org/content/28/2/123.full.pdf+html My conflict of interest declared: I am Editor of the Journal of Primary Health Care in which Greenhalgh's editorial is published. Felicity Goodyear-Smith Felicity Goodyear-Smith MB ChB MD FRNZCGP Professor & Goodfellow Postgraduate Chair Editor-in-Chief, Journal of Primary Health Care Department of General Practice & Primary Health Care University of Auckland PB 92 019 Auckland 1142 New Zealand Tel DD +64 (0) 9 923 2357 Mob +64 (0) 21 897 244 Fax: +64 (0) 373 7624 [log in to unmask]<mailto:[log in to unmask]> From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Poses, Roy Sent: Friday, 6 July 2012 8:01 a.m. To: [log in to unmask] Subject: Re: Editorial by Greenhalgh Greenhalgh seems confused, perhaps deliberately, between true EBM, and people who call what they are doing "evidence-based" as a marketing or public relations ploy. On Tue, Jul 3, 2012 at 12:54 PM, Amy Price <[log in to unmask]<mailto:[log in to unmask]>> wrote: I find this quote particularly onerous "On the other hand, I think something sinister is happening, mainly because of the striking circumstantial resonance between the reductionism of EBM and the reductionism of contemporary policymaking". How is this not a slap in the face? I as a newly minted EBHC student have already been forced to justify by several as if this was a done deal and we are no better than Pharma and their 3b fiasco. People understand this to mean that we are using EBM to rob people of their healthcare rights. Junk science medics are saying see we are free, people that practice EBM are bought and paid for bean counters. If they challenge me, who has not challenged back, has little public exposure and is not making any income on this how do you think this wave is going to roll for those who have invested their research in this practice.... Everything that can be will be used to control behavior and it is good to be aware but more importantly what constructive plans are in place to neutralize this in tangible ways? Fanaticism is rampant in all disciplines and is a reflection of lack of understanding and personality involved. EBHC is not a religion it is a dynamic clinical tool to promote understanding/discerning of quality research and clinical care Amy -- Roy M. Poses MD FACP President Foundation for Integrity and Responsibility in Medicine (FIRM) [log in to unmask]<mailto:[log in to unmask]> Clinical Associate Professor of Medicine Alpert Medical School, Brown University [log in to unmask]<mailto:[log in to unmask]>