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However, when evidence is lacking for a given patient, medicine is best practised by extrapolation from available evidence, interpreted in the light of the pathophysiology of the condition under consideration, and effects of various therapies in relation to that pathophysiology.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>To assess ways in which the unthinking application of EBM can go wrong; these include withholding therapy in patients whose subgroup was excluded from clinical trials, blind acceptance of the numbers, reliance on studies with crucial design flaws and reliance on intention-to-treat analysis when it is not appropriate.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Study selection<\/jats:title>\n<jats:p>Examples assessed included withholding cholesterol-lowering therapy in the elderly, not using B-vitamin therapy for stroke prevention, not using revascularisation for true renovascular hypertension and avoiding statin therapy for fear of intracerebral haemorrhage.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Findings<\/jats:title>\n<jats:p>Zealous application of EBM is often inappropriate.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In some instances, when there is a lack of evidence, or faulty interpretation of the evidence, clinical judgement should inform the application of EBM.<\/jats:p>\n<\/jats:sec>","DOI":"10.1136\/bmjebm-2019-111300","type":"journal-article","created":{"date-parts":[[2019,12,5]],"date-time":"2019-12-05T22:15:30Z","timestamp":1575584130000},"page":"172-177","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["The need for clinical judgement in the application of evidence-based medicine"],"prefix":"10.1136","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7478-1098","authenticated-orcid":false,"given":"J. 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