{"id":"https://openalex.org/W2034401866","doi":"https://doi.org/10.1016/s0002-9343(97)00244-1","title":"Problems in the \u201cEvidence\u201d of \u201cEvidence-Based Medicine\u201d","display_name":"Problems in the \u201cEvidence\u201d of \u201cEvidence-Based Medicine\u201d","publication_year":1997,"publication_date":"1997-12-01","ids":{"openalex":"https://openalex.org/W2034401866","doi":"https://doi.org/10.1016/s0002-9343(97)00244-1","mag":"2034401866","pmid":"https://pubmed.ncbi.nlm.nih.gov/9428837"},"language":"en","primary_location":{"id":"doi:10.1016/s0002-9343(97)00244-1","doi":"https://doi.org/10.1016/s0002-9343(97)00244-1","is_oa":true,"landing_page_url":"https://doi.org/10.1016/s0002-9343(97)00244-1","pdf_url":null,"source":{"id":"https://openalex.org/S186920367","display_name":"The American Journal of Medicine","issn_l":"0002-9343","issn":["0002-9343","1555-7162"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-2","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The American Journal of Medicine","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://doi.org/10.1016/s0002-9343(97)00244-1","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5023783600","display_name":"Alvan R. Feinstein","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I32971472","display_name":"Yale University","ror":"https://ror.org/03v76x132","country_code":"US","type":"education","lineage":["https://openalex.org/I32971472"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Alvan R Feinstein","raw_affiliation_strings":["Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06510, USA","Departments of Medicine and Epidemiology, Yale University School of Medicine, New Haven, Connecticut, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06510, USA","institution_ids":["https://openalex.org/I32971472"]},{"raw_affiliation_string":"Departments of Medicine and Epidemiology, Yale University School of Medicine, New Haven, Connecticut, USA","institution_ids":["https://openalex.org/I32971472"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5072546221","display_name":"Ralph I. Horwitz","orcid":"https://orcid.org/0000-0002-1224-2723","observed_orcids":["https://orcid.org/0000-0002-1224-2723"]},"institutions":[{"id":"https://openalex.org/I32971472","display_name":"Yale University","ror":"https://ror.org/03v76x132","country_code":"US","type":"education","lineage":["https://openalex.org/I32971472"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Ralph I Horwitz","raw_affiliation_strings":["Departments of Medicine and Epidemiology, Yale University School of Medicine, New Haven, Connecticut, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Departments of Medicine and Epidemiology, Yale University School of Medicine, New Haven, Connecticut, USA","institution_ids":["https://openalex.org/I32971472"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":[],"corresponding_institution_ids":["https://openalex.org/I32971472"],"apc_list":{"value":3770,"currency":"USD","value_usd":3770},"apc_paid":{"value":3770,"currency":"USD","value_usd":3770},"fwci":40.157,"has_fulltext":false,"cited_by_count":668,"citation_normalized_percentile":{"value":0.99896795,"is_in_top_1_percent":true,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":98,"max":100},"biblio":{"volume":"103","issue":"6","first_page":"529","last_page":"535"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12664","display_name":"Clinical practice guidelines implementation","score":0.4779999852180481,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12664","display_name":"Clinical practice guidelines implementation","score":0.4779999852180481,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11744","display_name":"Health Sciences Research and Education","score":0.4381999969482422,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10206","display_name":"Meta-analysis and systematic reviews","score":0.04540000110864639,"subfield":{"id":"https://openalex.org/subfields/1804","display_name":"Statistics, Probability and Uncertainty"},"field":{"id":"https://openalex.org/fields/18","display_name":"Decision Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/evidence-based-medicine","display_name":"evidence-based medicine","score":0.9990000128746033},{"id":"https://openalex.org/keywords/meta-analysis","display_name":"meta-analysis","score":0.8579999804496765},{"id":"https://openalex.org/keywords/subgroup-analysis","display_name":"subgroup analysis","score":0.824999988079071},{"id":"https://openalex.org/keywords/intention-to-treat-analysis","display_name":"intention-to-treat analysis","score":0.8009999990463257},{"id":"https://openalex.org/keywords/prophylaxis","display_name":"prophylaxis","score":0.6110000014305115},{"id":"https://openalex.org/keywords/clinical-judgment","display_name":"clinical judgment","score":0.5450000166893005},{"id":"https://openalex.org/keywords/quality-of-evidence","display_name":"quality of evidence","score":0.4699999988079071},{"id":"https://openalex.org/keywords/individual-patient-care","display_name":"individual patient care","score":0.5400000214576721}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8967371582984924},{"id":"https://openalex.org/C168563851","wikidata":"https://www.wikidata.org/wiki/Q1436668","display_name":"Randomized controlled trial","level":2,"score":0.6543196439743042},{"id":"https://openalex.org/C19648533","wikidata":"https://www.wikidata.org/wiki/Q691640","display_name":"Evidence-based medicine","level":3,"score":0.5617889165878296},{"id":"https://openalex.org/C150966472","wikidata":"https://www.wikidata.org/wiki/Q3410145","display_name":"Psychosocial","level":2,"score":0.5515687465667725},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.5218721628189087},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.5052223801612854},{"id":"https://openalex.org/C535046627","wikidata":"https://www.wikidata.org/wiki/Q30612","display_name":"Clinical trial","level":2,"score":0.4938419461250305},{"id":"https://openalex.org/C2779974597","wikidata":"https://www.wikidata.org/wiki/Q28448986","display_name":"Clinical Practice","level":2,"score":0.4680105447769165},{"id":"https://openalex.org/C2778012447","wikidata":"https://www.wikidata.org/wiki/Q1034415","display_name":"Scope (computer science)","level":2,"score":0.4266803562641144},{"id":"https://openalex.org/C204787440","wikidata":"https://www.wikidata.org/wiki/Q188504","display_name":"Alternative medicine","level":2,"score":0.4255772531032562},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.3191603422164917},{"id":"https://openalex.org/C118552586","wikidata":"https://www.wikidata.org/wiki/Q7867","display_name":"Psychiatry","level":1,"score":0.2592930197715759},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.11659923195838928},{"id":"https://openalex.org/C142724271","wikidata":"https://www.wikidata.org/wiki/Q7208","display_name":"Pathology","level":1,"score":0.11328843235969543},{"id":"https://openalex.org/C199360897","wikidata":"https://www.wikidata.org/wiki/Q9143","display_name":"Programming language","level":1,"score":0.0},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.0},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.0},{"id":"https://openalex.org/C199539241","wikidata":"https://www.wikidata.org/wiki/Q7748","display_name":"Law","level":1,"score":0.0}],"mesh":[{"descriptor_ui":"D003657","descriptor_name":"Decision Making","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D012307","descriptor_name":"Risk Factors","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D016032","descriptor_name":"Randomized Controlled Trials as Topic","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D019317","descriptor_name":"Evidence-Based Medicine","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true}],"locations_count":2,"locations":[{"id":"doi:10.1016/s0002-9343(97)00244-1","doi":"https://doi.org/10.1016/s0002-9343(97)00244-1","is_oa":true,"landing_page_url":"https://doi.org/10.1016/s0002-9343(97)00244-1","pdf_url":null,"source":{"id":"https://openalex.org/S186920367","display_name":"The American Journal of Medicine","issn_l":"0002-9343","issn":["0002-9343","1555-7162"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-2","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The American Journal of Medicine","raw_type":"journal-article"},{"id":"pmid:9428837","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/9428837","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The American journal of medicine","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.1016/s0002-9343(97)00244-1","doi":"https://doi.org/10.1016/s0002-9343(97)00244-1","is_oa":true,"landing_page_url":"https://doi.org/10.1016/s0002-9343(97)00244-1","pdf_url":null,"source":{"id":"https://openalex.org/S186920367","display_name":"The American Journal of Medicine","issn_l":"0002-9343","issn":["0002-9343","1555-7162"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-2","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The American Journal of Medicine","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.8560000061988831,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":32,"referenced_works":["https://openalex.org/W17094332","https://openalex.org/W33422408","https://openalex.org/W1509177569","https://openalex.org/W1562957001","https://openalex.org/W1980364638","https://openalex.org/W1985060436","https://openalex.org/W1985523305","https://openalex.org/W1994898034","https://openalex.org/W2015112316","https://openalex.org/W2021082217","https://openalex.org/W2029045893","https://openalex.org/W2031385454","https://openalex.org/W2034680167","https://openalex.org/W2056083953","https://openalex.org/W2056789386","https://openalex.org/W2061137783","https://openalex.org/W2067550511","https://openalex.org/W2082942950","https://openalex.org/W2087851547","https://openalex.org/W2092365914","https://openalex.org/W2106952837","https://openalex.org/W2108425422","https://openalex.org/W2128655828","https://openalex.org/W2136575584","https://openalex.org/W2139108354","https://openalex.org/W2332694193","https://openalex.org/W2414525460","https://openalex.org/W2771927986","https://openalex.org/W3216342804","https://openalex.org/W4233881963","https://openalex.org/W4243530908","https://openalex.org/W4255399620"],"related_works":["https://openalex.org/W1988156546","https://openalex.org/W1992404051","https://openalex.org/W1985802923","https://openalex.org/W1986158999","https://openalex.org/W2128845144","https://openalex.org/W1972746174","https://openalex.org/W7098684587","https://openalex.org/W1929168249","https://openalex.org/W2081151156","https://openalex.org/W1982539494"],"abstract_inverted_index":{"The":[0,111,184,211],"proposed":[1,33],"practice":[2,34],"of":[3,25,42,52,70,84,103,175,187,203],"\"evidence-based":[4],"medicine,\"":[5],"which":[6],"calls":[7],"for":[8,49,86,92,153,161,179,231],"careful":[9],"clinical":[10,76,99,109,162,189,232],"judgment":[11],"in":[12,75,155],"evaluating":[13],"the":[14,22,32,39,50,63,79,125,198,216],"\"best":[15,43,208],"available":[16,152,209],"evidence,\"":[17],"should":[18],"be":[19,195],"differentiated":[20],"from":[21,58],"special":[23],"collection":[24,41],"data":[26,64,131],"regarded":[27],"as":[28,101,207],"suitable":[29,129],"evidence.":[30],"Although":[31],"does":[35],"not":[36,66,91,115],"seem":[37],"new,":[38],"new":[40],"available\"":[44],"information":[45,148],"has":[46],"major":[47,222],"constraints":[48],"care":[51],"individual":[53],"patients.":[54],"Derived":[55],"almost":[56],"exclusively":[57],"randomized":[59,89],"trials":[60],"and":[61,78,107,124,158,160,171,177,182,201],"meta-analyses,":[62],"do":[65,114],"include":[67],"many":[68],"types":[69],"treatments":[71],"or":[72,140,228],"patients":[73],"seen":[74],"practice;":[77],"results":[80,126],"show":[81],"comparative":[82],"efficacy":[83],"treatment":[85],"an":[87],"\"average\"":[88],"patient,":[90],"pertinent":[93],"subgroups":[94],"formed":[95],"by":[96,197],"such":[97],"cogent":[98],"features":[100],"severity":[102],"symptoms,":[104],"illness,":[105],"co-morbidity,":[106],"other":[108],"nuances.":[110],"intention-to-treat":[112],"analyses":[113],"reflect":[116],"important":[117],"post-randomization":[118],"events":[119],"leading":[120],"to":[121,215,221],"altered":[122],"treatment;":[123],"seldom":[127,151],"provide":[128],"background":[130],"when":[132,141],"therapy":[133],"is":[134,149,205],"given":[135,214],"prophylactically":[136],"rather":[137],"than":[138],"remedially,":[139],"therapeutic":[142],"advantages":[143],"are":[144],"equivocal.":[145],"Randomized":[146],"trial":[147],"also":[150],"issues":[154],"etiology,":[156],"diagnosis,":[157],"prognosis,":[159],"decisions":[163,190],"that":[164,224],"depend":[165],"on":[166,192],"pathophysiologic":[167],"changes,":[168],"psychosocial":[169],"factors":[170],"support,":[172],"personal":[173],"preferences":[174],"patients,":[176],"strategies":[178],"giving":[180],"comfort":[181],"reassurance.":[183],"laudable":[185],"goal":[186],"making":[188],"based":[191],"evidence":[193],"can":[194],"impaired":[196],"restricted":[199],"quality":[200],"scope":[202],"what":[204],"collected":[206],"evidence.\"":[210],"authoritative":[212],"aura":[213],"collection,":[217],"however,":[218],"may":[219],"lead":[220],"abuses":[223],"produce":[225],"inappropriate":[226],"guidelines":[227],"doctrinaire":[229],"dogmas":[230],"practice.":[233]},"counts_by_year":[{"year":2026,"cited_by_count":15},{"year":2025,"cited_by_count":22},{"year":2024,"cited_by_count":14},{"year":2023,"cited_by_count":15},{"year":2022,"cited_by_count":21},{"year":2021,"cited_by_count":8},{"year":2020,"cited_by_count":35},{"year":2019,"cited_by_count":19},{"year":2018,"cited_by_count":24},{"year":2017,"cited_by_count":24},{"year":2016,"cited_by_count":16},{"year":2015,"cited_by_count":26},{"year":2014,"cited_by_count":25},{"year":2013,"cited_by_count":26},{"year":2012,"cited_by_count":22}],"updated_date":"2026-11-07T11:25:07.637180","created_date":"2016-06-24T00:00:00"}
