I am often (pleasantly) surprised by the spread of evidence-based medicine (EBM) around the world. On recent visits to Oman, Iran, Jakarta, and elsewhere I've found a high level of interest in and practice of EBM. The same issues and questions seem to occur there as in English-speaking countries: is it practical? Does it neglect clinical experience and expertise? Are randomised controlled trials always necessary? Can guidelines replace EBM? What about patients’ unique circumstances and values? Of course, there are additional problems because of limited access …