Evidence-based treatment recommendations - between supposition and knowledge

The assessment of the potential benefit of medical drugs (and other types of medical interventions) is based on the current best available evidence from experimental and observational trials. Benefit assessment implies one fundamental assumption: the results published in the international literature actually have practical relevance for the future treatment of individual patients. This assumption is, in turn, based on a number of pre-conditions, six of which will be identified and discussed: an established nosology, the priority given to treatment implications, valid and reliable comparative measurement of outcomes, aggregate statistics for different types of outcome variables, and irrelevance of the psychosocial context of health care. Once more it will be demonstrated that the fundamental basis of any medical benefit assessment is a weak one in various parts and needs continuous theoretical reflection.