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EDITOR,-It is reassuring that David L Sackett and colleagues have made two important concessions from their previous extreme position relating to evidence based medicine 1 2 : firstly, they have recognised the importance of clinical skill, as distinct from the consideration of scientific evidence; and, secondly, they have allowed other forms of evidence to take a step towards the hallowed position held by the randomised controlled trial.
A contradiction then ensues. Clinical skill is essentially derived from experience and is expressed as judgment in decision making. 2 But the variation in the ways in...