Should RCT's be used as the gold standard for evidence based medicine?

Evidence Based Medicine (EBM) seeks to use the best available evidence in making sound clinical decisions while caring for patients.1 It seeks to integrate clinical judgment on the part of the physician, the best clinical evidence obtained through robust scientific research methodology, and the patient's values and preference.This is clearly a desirable aim that would benefit patients.This is because physicians with years of experience generally have developed clinical judgment and expertise that enables them to make sound diagnoses while also factoring in any special circumstances and preferences of their patients and their caregivers when developing a patient care plan.External clinical evidence has the positive potential to replace old diagnostic tests and/or treatments with newer tests or treatments that are more effective or may have less deleterious side effects. 1 It is clear that a physician who does not incorporate currently available best evidence risks having a practice that is out of date.So it is fair to say that the goal of EBM is a good one but it is at this point difficulties arise in clearly defining what constitutes EBM.EBM seeks to use "evidence" in the practice of medicine.2 According to this approach, RCTs or the systematic review of many randomized trials offer better evidence than can be obtained from say, observational studies. 2 To understand the basis of this belief we need to look a bit more closely at what a RCT seeks to achieve.The use of a control is an element that imparts validity to RCTs.Such a control is a means of ensuring that only one factor is being tested at a time and there aren't any other variables at work that could introduce a bias of some sort and impact results.Additionally, by including a placebo comparison RCTs may attempt to blind participants, intervention providers and other trial stakeholders