No guidance is provided for situations for which evidence is lacking

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Abstract
EDITOR,--The paradigm of evidence based medicine provides clear guidance for making decisions about the delivery of health care in populations.1 2 Therefore, it must be qualified so that it can be used for managing specific patients. Evidence based medicine finds answers only to those questions open to its techniques; randomised controlled trials are its capstone. Other types of evidence, including natural observations and pathophysiological principles, are ranked lower and heavily discounted. Nevertheless, for many rare disorders and an increasing number of subgroups …