Evidence-based medicine, cost-containment, care effectiveness: is it a new trilogy aimed at transforming the surgical mystique or the reality of double standards?

Clinically relevant attitudes and guidelines issued by a rational Evidence-Based Medicine (EBM) approach integrate individual clinical expertise with the best available external clinical evidence from systematic research. However, many surgeons, while considering the ultraliberal world they are practicing in and fearing that the primary goal of managed care in a market environment is reducing cost in order to make profit or decrease spending, remain suspicious of this kind of tentative protocol-driven medicine when applied to surgical practice. If surgeons want to develop a health policy agenda that emphasizes patient care issues above provider's or payor's interests, they should also enhance education programs, improve continuing objective assessment of the way surgery is performed, face moral issues raised by innovation, and assume an increased leadership role in sound critical evaluation of nonvalidated new techniques. They should no more consider EBM as a weapon turned against the surgical profession, but as a tool that may provide some answers to chronically unresolved questions in the evolving art of surgery.