TY - JOUR T1 - Evidence-based medicine has already adapted and is very much alive JF - BMJ Evidence-Based Medicine JO - BMJ EBM SP - 261 LP - 262 DO - 10.1136/bmjebm-2022-112046 VL - 27 IS - 5 AU - Mohammad Hassan Murad AU - Samer Saadi Y1 - 2022/10/01 UR - http://ebm.bmj.com/content/27/5/261.abstract N2 - Greenhalgh et al 1 argue that the COVID-19 pandemic has uncovered a need for a shift in the evidence-based medicine (EBM) paradigm in which mechanistic evidence is also used as a complementary source for decision-making. Their justification is based on limitations of evidence hierarchies, which prioritise meta-analyses and randomised controlled trials (RCTs)1; and the urgency, threat and complexity of a pandemic. However, in defence of EBM, we present a counter argument.First, mechanistic evidence may be misleading. Textbooks of clinical epidemiology and EBM manuals include numerous examples of mechanistic evidence supporting various treatments that subsequently turned out to be ineffective or harmful.2 A recent example, hydroxychloroquine has antiviral activity in vitro inhibiting viral entry, uncoating, assembly and budding through different molecular mechanisms.3 Yet, trials in thousands of patients have shown that hydroxychloroquine is not effective and is only exposing patients to adverse events.3 When we … ER -