Comments like this one are the main reason for the skepticism that blogs generate when research in biomedical science is debated by anybody with an e-mail address, rather than a qualified expert in the subject of the publication. Medicine IS SCIENCE my friend, and the probabilistic reasoning behind the deductions that lead to both diagnosis and treatment in the care of human beings has solid foundations in scientific method.Without the need to resort to useless ad hominem attacks (more typical of Yahoo discussion boards) I'll simply point to the obvious: A mechanistic approach to biological systems is causal oversimplification. Why you may dare ask? Once the clear diferences between a flying aluminum tube (with hydraulics, avionics, electrical and computational systems plus the life support for in fly crew and passengers) and the simplest pathogenic prokaryote (with genetic information stored in circular DNA for over 2,000 proteins, plus the mechanism for the translation and replication of said infomation, the energy balance, cellular elements synthesis and metabolism) become apparent, you must factor in evolutionay pressures within the microenviroment, competence for substrates and interactions with the other cellular elements in the vicinity, and at some point add up host interactions (cellular, humoral, mechanical, etc) that varies from host to host depending on certain phenotypical expresions and their own evolutionary drift ad nauseaum.... well you get the idea. If there's a field as complex as biological systems interactions within Chemistry, Applied Physics or Engineering, I respectfully request references to the published works, for opinions must be backed with facts. In the meantime, an explanation of how gravity pulls the remote out of your hand (or what gravity is for that matter) of how a LASER (Light Amplification by Stimulated Emission of Radiation) "lase" will be appreciated.

Evidence-Based Medicine is only as good as the data that supports its conclusions, and the sad truth is that we just don't know all the variables involved. We physicians strive to give our patients with the type of care you demmand, by giving them information to make educated choices. In doing so we stick to what it works, and that body of knowledge steamed from centuries of trial and error. How many papers I have read already where the latest metanalysis on whatever pool of papers arrive to the exact opposite conclussion of the metanalysis of last month (hailed as the much expected answer to a clinical dilemma, the effects of labor support anybody?), and just how much of the actual evidence that guides our day to day decision making are level 1 recommendations? (less than 5% is my "educated guess"), and how many EBM champions make a name to themselves by deriding colleagues work instead of contributing to the pool of knowledge (BMJ and the "Surgical research or comic opera debate"). EBM has an undeniable role in modern healthcare, as a paradigm shift the real questions is what that role is.