Abstract
Frustrating to some and exhilarating to others, medical knowledge is in continual evolution. Medicine’s evidence base evolves in many ways, sometimes in ways that can be compared to random mutations (such as adverse effects of a drug leading to investigation of its use where the effect could be beneficial) and other times through selection pressure that allows substandard evidence to flourish in ecological niches (such as a research community accepting existing reports as an established and unquestioned foundation). We describe several ways in which pathways resembling aberrant evolutionary changes distort our evidence base (how has our evidence evolved?), and discuss areas where evidence-based medicine (EBM) processes can adapt (how does EBM need to evolve?).
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