• evidence based medicine

During the past two decades the essentially anecdotal nature of medical practice has been largely replaced by “evidence based medicine.”¹ Evidence based medicine incorporates the most reliable reproducible data from clinical studies, particularly clinical trials. Indeed, the multicentre, prospective, randomised clinical trial has become the gold standard by which other clinical data are now judged. The impact of this change on medical publications has been profound and cannot be overemphasised. Prospective rather than retrospective studies are more likely to be published. Studies with inappropriate or no controls are often rejected outright. Appropriate use of statistics is now essential for publication of even the most straightforward clinical study. All of these changes are appropriate and make it more likely that data published today will still be useful in the future. On the other hand, do we really believe that no useful data can be obtained from a thoughtful small case series or even from the lowly case report?

In this issue of the BJO we introduce a new feature entitled “Hypothesis.” This feature will not be published in every issue of the journal, and we will not solicit papers for it. However, when one of the editors identifies a paper that raises what appear to be important clinical issues (we will not include any laboratory science studies) but does not contain all the necessary data to address the issues …