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Essential medicines and the challenges in the Evidence-Based Manifesto
  1. Nav Persaud1,2
  1. 1 Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
  2. 2 Centre for Urban Health Solution, St Michael’s Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr. Nav Persaud, Department of Family and Community Medicine, University of Toronto, Toronto ON M5S 3H7, Canada; nav.persaud{at}

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The Evidence-Based Medicine Manifesto aptly identifies massive ‘too much’ problems: too much hidden information, too much bias, too much research waste and too much overtreatment.1 2 One potential solution is to focus efforts on a small number of needed treatments while allowing all the excess to fall by the wayside. Here I explore the potential role of the essential medicines list (EML) in meeting some of the big challenges posed in the Manifesto.

What is an essential medicines list?

EMLs usually include around 300 medicines that meet the priority needs of a population.3 4 The WHO created its Model EML in 1977, and since then more than 100 countries have adapted the WHO’s Model EML to their own circumstances.3 4 Today more than five billion people live in a country with an EML.

Ultimately we need to know which treatments should be used and EMLs are ‘positive lists’ that can help direct people to effective treatments (as opposed to ‘negative lists’ of medicines to avoid). Given all the clinical research that has been done over the decades, we ought to be able to write down a list of medicines that were proven to have important benefits without excessive harms in studies that were properly done and reported. The fact that it is …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.