Evidence in medicine: invited commentary

In the practice of medicine, evidence pertains to “gnosis ” — diagnosis, etiognosisand prognosis. Specific, ad hoc evidence is constituted by the patient profile inknown, gnosis-relevant respects, and this is interpreted — translated to gnostic probability — in the light of general, ideally scientific, evidence specific to the profile. The scientific evidence is about rates in defined domains and, ultimately, their profile-defining subdomains. Scientific evidence expressly relevant to diagnosis and etiognosis is almost nonexistent today, and intervention-prognostic research, while already appre-ciable in quantity, tends to lack relevance to practice mainly on account of relative inat-tention to the pivotal element in all practice-oriented research — express, principles-guided and detailed design of the object of study with a view to its relevance for practice, this in lieu of just an aprioristic and loose definition of it. Reporting of inter-vention-prognostic studies and syntheses of their results, too, remain underdeveloped. The current deficiencies in the scientific evidence for, and consequently in the scientific knowledge-base of, the practice of medicine constitute a challenge that clinical acade-mia must, and increasingly will, meet — in partnership with editors of medical journals. It speaks to the enlightenment of the editors of the Canadian Medical Association Journal that they, in their letter to me, have expressed concern about the prevailin