A critical review of evidence-based medicine: The need for moving toward real evidence-based medicine

About 25 years have been passed since the evidence-based medicine (EBM) group declared it as a new approach to teaching and practicing clinical medicine. EBM was based on the combination of three principles: use of current best evidence from research, clinical expertise, and patient's values and preferences. Practically, EBM substitutes pathophysiological reasoning based on basic science research with use of clinical evidence from high quality randomized controlled clinical trials. Like all other approaches to clinical medicine, EBM has been criticized since it was introduced. Herein, we review common problems of EBM according to its critics, introduce what is known as real EBM, and briefly discuss how we could move towards real EBM.