Evidence-based medicine:Can you have too much of a good thing?

The above was a provocative title from an article by Michael Asby,Director of the Centre for Palliative Care, Melbourne University, based at St Vincent’s Hospital Melbourne, that appeared in the July 2006 edition of HLA NEWS the National Newsletter of Health Libraries Australia, a group of the Australian Library and Information Association.
To quote from the summary:

"Professor Ashby contends that in this age of evidence-based medicine with its push for high level evidence, medicine cannot afford to ignore clinician experience. The author also provides some insight into the way in which instant global communication contributes to the advancement of
therapeutic interventions."

"The modern evidence-based medicine movement has tried to imbue the whole of medicine with a scientific evaluative approach to practice based on good quality studies and this is clearly correct. The pinnacle in the hierarchy of evidence for medical treatment is the randomised controlled trial (RCT), with appropriate blinding to remove bias. Manifestly all new drugs require rigorous testing, including RCTs. He cautions though "however, all good ideas have the potential to overshoot and become oppressive. Many questions and therapies will never be subjected to clinical trials, but will rise or fall on personal orlocal experience, and others are not amenable to study by RCT. In fact if we relied solely on RCT and other suitably elevated levels of evidence, then very little would change, and we would be faced with therapeutic paralysis. Whilst it seems without question that good quality trials should be designed, wherever possible and practicable, for important therapeutic questions, it is disastrous if clinical experience is trivialised or downgraded"
see the article at this link