The concept of evidence-based medicine came like a breath of fresh air to the medical community. It helped, up to a point, to exclude bias and to base decisions on solid science. But perhaps our expectations of it were unrealistic? Plenty of questions have been asked, but they are not taken seriously.

Questions like, who generates evidence? Ninety per cent of scientific medical studies are funded by the pharmaceutical industry.

Does that not automatically exclude studies (and thus evidence) in favour of inexpensive medication?

And not forgetting the recent recommendations that negative results must be published, can we realistically expect implementation of this recommendation?

And finally, in the matter of something as subjective as pain or distress, is it reasonable to rely only on grade 1 evidence?

These are factors that we must consider when evaluating the recent NICE guidelines about management of low back pain.

Read about the controversy in the 2009 autumn issue of British Pain News…

It is dangerous to let any concept – evidence-based medicine included – assume the status of a religion where challenging it invokes wrath and holy wars!