Despite the rigorous academic basis, the statistical validation, the scientific approach, which it is, the resulting best evidence protocol stifles the imagination, the trial and error, the inductive reasoning of the scientific method and the focus on individual patients. Medical-legally, best evidence tends to overshadow, well documented past studies, antidotal wisdom and individualized imaginative initiatives - progress itself and time - focusing instead on education reform, and training young physicians to a rigid structured algorithm, physicians who will follow the rules. Furthermore, mass studies of distant populations, fail to account for the environment, DNA, local epidemiology or personal concerns. It may even codify some highly profitable practices contributing gladly to the terms of best evidence.
Considering the cost, the dismal status of EHRs, professional communication and continuity of care, one might "sell short" and look beyond best evidence for the next higher level of academic and professional excellence, perhaps the genome and quantum biology, requiring a PhD MD rather than a Feldsher.
