Perspective on consensus studies in the absence of prospective trials

摘要

Prospective multicenter trials have become the Holy Grail of medical care. By providing natural history information as well as response to treatment we often find "What we knew" to be unture. Unfortunately true prospective randomized trials of adequate power are extremely uncommon. Nonetheless, the push to true "evidence based medicine" often points out how little we truly know about common disease processes. The lack of evidence based data, however, does not mean that we are not responsible for making appropriate clinical decisions based on analysis of risk benefit ratio with the best material we have available. That is why consensus studies such as "Evidence-based review of recommendations for visual function testing in patients treated with Vigabatrin" remain important in advising the best clinic practice in the absence of true multi-centered trials. There is of course the possibility that substituting "eminence based "for "evidence based" medicine can be seen as equivalent or at least of equal weight. That unfortunately is not true since even experts are limited by their experience.