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Evidence and opinion: finding the proper balance.

DOI:10.1097/GCO.0b013e328355cb90 The medical literature has changed radically in the past decade. For many years, case reports and small series of similarly diagnosed patients ruled the professional journals. This was followed by the cohort and case–control studies, which sought to answer medical queries in a more organized manner. Through the 1980s, these study designs dominated the clinical literature, impacting greatly upon the practice of medicine. However, in the early 1980s a new type of study design began to emerge; one previously recognized as of much higher quality than the cohort study but also considered both difficult and expensive to accomplish: the randomized controlled trial (RCT). Studies utilizing this experimental design were few and far between, but were also recognized as providing the finest evidence attainable. Slowly, but surely, a greater number of RCTs crept into the evidence, based upon which we rely for clinical decision making, often confirming but sometimes drastically altering the landscape upon which we painted clinical practice. As these studies became more numerous and encompassing, the systematic review and meta-analysis became mechanisms to collate these studies and provide consensus answers to complex issues. In 2012, the majority of manuscripts published in quality journals are in fact RCTs, systematic reviews and meta-analyses. Yet here we present a journal termed Current Opinion in Obstetrics and Gynecology. In this age of high volume experimental clinical research, is there still a need for a review journal touting opinion in its title? The answer, I believe, is a resounding yes! RCTs in most cases require a rather homogeneous patient population; whether that population is a good match to the woman sitting across from you in your office is often a matter of opinion. Circumstances of the individual may well dictate the need for an approach different from the ‘definitive’ study that has been published. It should be kept in mind that evidence-based medicine requires the use of the best available evidence; this may well be evidence accumulated on the patient up until the time you see her, or the local (systematically collected) experience for women of similar backgrounds and diagnoses.