key: cord-0811864-9ktcv9ss
authors: Pieralli, Filippo; Vannucchi, Vieri; Olivotto, Iacopo
title: The eighth alternative to Evidence Based Medicine in the early era of the COVID-19 pandemic: too much Emergency and Emotion, too little Evidence.
date: 2020-05-28
journal: Eur J Intern Med
DOI: 10.1016/j.ejim.2020.05.040
sha: 336a540ccbe5f8949fa285fad907cc5b736b9379
doc_id: 811864
cord_uid: 9ktcv9ss

nan

The eighth alternative to Evidence Based Medicine in the early era of the COVID-19 pandemic: too much Emergency and Emotion, too little Evidence.

Filippo Pieralli 1 , Vieri Vannucchi 2 , and Iacopo Olivotto 3 . EBM determined a philosophical and intellectual revolution in the practice of modern medicine;

while imperfect and with limitations, it has permitted the transition from empiricism to the practice of medicine based on evidence obtained by a rigorous and scientifically oriented method. EBM has been criticized, misunderstood and misused over the years, even though its role and its rules remained evident to those who trusted and appreciated it [3] . In 2014, 22 years after the publication of its JAMA manifesto, Trisha Greenhalgh and others moved a substantial critique to EBM, emphasizing -along with many benefits -the unintended negative consequences and the need for new directions for EBM [4] .

The authors reaffirmed the original role of EBM, i.e. refocusing actionable and robust evidence in the appropriate context and with the professional expertise required to optimize individual patient care.

They named this process the Reinassance of EBM.

In late December 2019, an outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in Wuhan, China [5] .

The outbreak rapidly spread across continents becoming the ongoing pandemic which had For many of us who "grew up" during the affirmation of EBM, learning from its virtues and vices, the early era of COVID-19 pandemic represented the denial of more than 20 years of its history. After the EBM revolution, the present trend has taken the form of a counterrevolution with unacceptable consequences. Those who care for COVID-19 patients have felt on their skin a sense of skepticism turning to defeat and impotence while treating patients with drugs that seemed more toxic than effective [7] , based on inconsistent reports contradicting each other in a matter of weeks [8, 9] .

Unfortunately, the aphorism by Sir William Osler "We administer drugs we don't know in a body that we know even less" never sounded so true! [10] . All that proved to be too much Emergency-and Emotion-Based and too little Evidence Based Medicine.

Many methodologically sound clinical trials are ongoing in order to answer the unmet clinical needs for COVID-19 treatment, duly registered at ClinicalTrials.gov. We are anxiously awaiting those results to fill current gaps in knowledge and improve the delivery of appropriate care to our patients affected by COVID-19. Meanwhile, we must rely on the best of our knowledge, clinical experience and judgement, with a healthy dose of skepticism towards a flourish of "experts" in a disease that was totally unknown only four months ago.

Isaacs and Fitzgerald concluded their report with the comment that there "are plenty of alternatives for the practicing physician in the absence of evidence and this is what makes medicine an art as well as a science" [1] .

If Emotionality and Emergency should be the eighth alternative to Evidence (Table) , we will continue to prefer and promote the original EBM with no alternatives at all, practicing medicine as a science and an art of judicious balance between knowledge and clinical judgement in making decisions about the care of individual patients. 

Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine

Evidence based medicine: what it is and what it isn't

Evidence based medicine: a movement in crisis

World Health Organization. Novel Coronavirus -China Disease outbreak news update 12

A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19

Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial

Compassionate Use of Remdesivir for Patients with Severe Covid-19

Aphorisms from His Bedside Teachings and Writings

The authors declare that there is no conflict of interest