Experience is good, science is extolled. are they mutually exclusive? Is the scientific method the only path to knowledge. Is a randomized controlled trial really needed for everything? Can the effect be so robust based on historical "experience" as to obviate the need for a randomized trial. I think the discovery of penicillin was in this category. before most people died, and afterwards most lived. Is EBM over rated or maybe it needs to be used appropriately and selectively:
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So now we have the budget meisters, in the name of quality and safety, refusing requests from experienced clinicians for expensive new therapies. I requested dexmedetomidine from the UPenn P&T committee with use restricted to neuro patients. It has some qualities that seem perfect for this group, like producing a sedative state with easy arousability to do a neuro check. sorry....no rct's on dex for that purpose. Also, too expensive. doesn't much matter that there's not an RCT for the use of say, desflurane or sevo for cerebral aneurysm surgery, or even for a TURP......