Posted on July 13, 2015 · Posted in cardiology, News

by Seth J. Baum, MD

Our Guidelines have been hijacked by the “Evidenced Based Medicine” (EBM) initiative. Somehow, the “evidence” in EBM has been distorted to be tantamount to that which is derived solely from randomized controlled trial (RCT) data. Such a proposition is patently preposterous. Evidence comes in many forms – from basic scientific research to observational data and even non-randomized trial data. Babinski discovered his famed reflex by observing an abnormal response in some of his patients when he stroked their feet on morning rounds. The evidence he acquired was not randomized but surely made a major difference in our world.

Recently a JACC paper lauded advances in our Guidelines, specifically citing their dependence upon the RCT. When I read this, my blood initially boiled. Then I calmed myself and saw a solution. Here it is. There is no doubt that RCTs provide invaluable medical information, well suited to the clinical setting. So why not solve our semantic suffering and rename the Guidelines. Let’s dub them what they are, RCT Guidelines. By so doing we will immediately deflate any controversy associated with their intent. Anyone who wishes to practice outside such Guidelines by citing non-RCT evidence can do so with impunity. The argument can then shift to the relative value of different forms of evidence instead of the value of the guidelines themselves. Physicians and patients alike will become less confused, and I believe we will develop a more cohesive and effective medical system. Any honest doctor must admit that we have squandered too much time and energy debating the merits and flaws of the 2013 AHA/ACC Cholesterol Guidelines. Let’s move on and work together to address what really matters to us all, helping limit and even eradicate the scourge of ASCVD that engulfs our nation and much of the world.