http://truthman30.wordpress.com/2012/12/01/david-healy-time-to-abandon-evidence-based-medicine/ I've just listened to this lecture by prof Healy on the failings of evidence based medicine. He makes a lot of interesting points starting with the traditional regulation of trials. But he goes on to cover adverse effects where the adverse effects from a drug overlap with the disease, a brief mention of the issue of scales. I liked one comment he made around if you can show a good effect with 10 patients why do you need a bigger trial. He also said there is no point of a rct if you cann't define your patient His basic thesis is doctors are ignoring evidence of adverse effects because trials tell them they don't happen. He runs an organisation called risk.org for reporting and sharing adverse drug effects. Many of the issues we have with trials are mentioned.