Fallacies of Evidence-Based Medicine in Cardiovascular Medicine

Evidence-based medicine (EBM) has gained a dominant role as the backbone of modern medical activities since its definition about 20 years ago. It serves the purpose to unify and optimize patient management and minimize scientific bias and fraud. The article looks, in the realm of cardiovascular medicine, at the banes of overly rigorous application of EBM with insufficient counterbalancing of other decision criteria. It exemplifies based on fictitious and real trials where EBM does not make sense, can be misleading, or has been inappropriately applied. Closure of the patent foramen ovale and percutaneous coronary intervention are focused upon as 2 major examples. Without abrogating the merits of EBM, concern has to be raised about the risk of increasingly putting EBM first. Neglecting experience and common sense in patient-management as a consequence is not in the interest of mankind.