The end of evidence-based medicine?

It is customary for physicians and surgeons to recommend treatments that have the highest probability of getting the patient a good outcome. Deciding treatment based on results (outcomes actually achieved) has been advocated for hundreds of years. We are now in an era when practice recommendations are supposed to be based on evidence from randomized controlled trials. There are many defects in relying on RCTs which are reviewed in this article. Advantages of observational studies are outlined, and the importance of assessing one's actual results when applying a treatment based on controlled trial evidence is set out.