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Clinical guidelines at stake
  1. Antonio Sitges-Serra
  1. Correspondence to Professor Antonio Sitges-Serra, Department of Surgery, Hospital del Mar, Passeig Marítim, 25-29, Barcelona 08003, Spain; asitges{at}hospitaldelmar.cat

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The knowledge imposes a pattern, and falsifies, for the pattern is new in every moment and every moment is a new and shocking valuation of all that we have been. East Coker, T.S. EliotMedicine is not a science: it is a cultural product. As such, the way it is practiced and conceived is much affected by cultural contexts, academic traditions, politics, personal interests, the health industry, experts’ and medical bodies’ opinions, journalists and medical publishing companies. Obviously, science and research have played and will continue to play a key role in the development and progress of medical knowledge. Science, however, proceeds slowly, requires the test of time and relies on strict methodological principles and in personal integrity; briefly, good science is at stake in a world dominated by technolatry1: a self-imposed commitment for continuous innovation within an industrial culture dominated by planned obsolescence and profit increase for the myriad companies that live on the global health market.

Evidence-based medicine was launched to encourage a scientific and proof-based approach to medical practice.2 As an ideological movement, it has had a significant impact on how doctors read the medical literature, how clinical research should be planned and how new concepts and therapies are scrutinised before being implemented. However, because medicine, in opposition to science, requires bedside decision making, it cannot rely only on hard data. First, because in many domains, such hard, class A data are not available in many instances. Second, the robustness of the data may be challenged by new findings. Third, because the clinical setting is much more complex than the scenario created by clinical trials that, in order to obtain meaningful conclusions, oversimplifiy the decision-making process through strict inclusion and exclusion criteria. Fourth, because the acquisition and implementation of new knowledge is …

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