Evidence-Based Medicine vs Physiology-Based Medicine: A False Dichotomy?

Evidence-based medicine (EBM) has profoundly influenced modern clinical practice by promoting standardized, data-driven decision-making derived from randomized trials and systematic reviews. In critical care, however, the increasing reliance on protocols and numerical targets has exposed important limitations related to patient heterogeneity, dynamic pathophysiology, and restricted external validity of population-based evidence. Physiology-based medicine (PBM), grounded in mechanistic understanding and continuous bedside interpretation of biological responses, has often been portrayed as subjective or insufficiently rigorous, fostering an artificial opposition between the two approaches. This viewpoint argues that the perceived conflict between EBM and PBM represents a false dichotomy. Rather than competing paradigms, they constitute complementary components of sound clinical reasoning.

Using examples from hemodynamic resuscitation, mechanical ventilation, oxygen therapy, and metabolic support, we illustrate how rigid application of evidence without physiological contextualization may obscure clinically relevant signals, while physiology detached from evidence risks inconsistency. We propose an integrative framework in which evidence defines boundaries of safety and probability, while physiology guides individualized application at the bedside. Reaffirming physiology as the interpretive bridge for evidence is essential to restore clinical judgment, ethical accountability, and patient-centered care in complex clinical environments.

Keywords: Evidence-based medicine, physiology-based medicine, critical care, individualized patient care, clinical decision-making