I think there are many problems with what is known as “Evidence Based Medicine” (not least being the influence of vested interests such as Pharmaceutical companies on the production of “evidence”), and there is an interesting consideration of some of the issues in the BMJ. The paragraph on patients with multi-morbidity ie patients who are suffering from more than one chronic ailment at the same time caught my attention.
as the population ages and the prevalence of chronic degenerative diseases increases, the patient with a single condition that maps unproblematically to a single evidence based guideline is becoming a rarity. Even when primary studies were designed to include participants with multiple conditions, applying their findings to patients with particular comorbidities remains problematic. Multimorbidity (a single condition only in name) affects every person differently and seems to defy efforts to produce or apply objective scores, metrics, interventions, or guidelines.
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