Journal of

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According to evidence-based medicine, randomized controlled clinical trials are a group of research designs which provides the highest level of clinical evidence, particularly regarding therapeutic or preventive interventions. Considering the dramatic increase in the number of published clinical trials in medical journals, the readership need to have knowledge about the problems that may occur during design and conduct of these studies, as well as about proper reporting of them. Due to importance of these studies in clinical medicine, several guidelines have been developed regarding designing, conducting and reporting clinical trials. One of the most important guidelines which has been developed to alleviate the problems in reporting randomized clinical trials is Consolidated Standards for Reporting Trials (CONSORT). In this article, some crucial points with regards to the report of the comparison of outcomes of interventions in randomized controlled trials will be reviewed briefly.

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David Lawrence Sackett, OC, MD, FRSC, FRCP was an American-Canadian physician, trialist, and teacher. He is best known as one of the pioneers of evidence-based medicine (EBM), which is arguably the most important movement in medicine over the past three decades. He founded the first clinical epidemiology department in McMaster University in Hamilton, Canada in 1967. In addition, he was the head of the Center for the Evidence-Based Medicine in Oxford, UK. He also was the first chair of Cochrane Collaboration and the first founding coeditor of the journal of Evidence-Based Medicine and had many other honors. He published 12 books, 60 chapters in other books, and about 300 articles in scientific and medical journals. He died on May 13, 2015 at age 80 because of cholangiocarcinoma. While Dr. Sackett will be missed by his friends, colleagues, mentees as well as EBM proponents and followers all over the world, his contributions to EBM in particular, and to medicine in general will never be forgotten.

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Three decades have passed since the first time evidence-based medicine (EBM), in its current form, was introduced. Arguably, over the past two decades it has been the most significant movement in medicine. There is no need to emphasize any approach to clinical medicine practice, including EBM, has its proponents and opponents. Certainly, EBM has been subjected to many challenges and criticisms. Some of those challenges are basically related to misunderstanding and misinterpretations of EBM. However, there are some challenges that are real and are acknowledged by the most loyal EBM supporters. After hearing some criticisms posed by few knowledgeable and competent dermatologists during the recently held 7^th Evidence-Based Dermatology (EBD) seminar in Tehran, the authors of this letter, two of the pioneers of EBD in Iran, decide to open a gate for sharing and discussing different viewpoints on EBM and EBD.

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About 25 years have been passed since the evidence-based medicine (EBM) group declared it as a new approach to teaching and practicing clinical medicine. EBM was based on the combination of three principles: use of current best evidence from research, clinical expertise, and patients' values and preferences. Practically, EBM substitutes pathophysiological reasoning based on basic science research with use of clinical evidence from high quality randomized controlled clinical trials. Like all other approaches to clinical medicine, EBM has been criticized since it was introduced. Herein, we review common problems of EBM according to its critics, introduce what is known as real EBM, and briefly discuss how we could move towards real EBM.

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