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Industrial, but not ruminant, trans fats were associated with CHD mortality (1.18 (1.04 to 1.33) -palmitoleic acid was inversely associated with type 2 diabetes (0.58, 0.46 to 0.74).The certainty of associations between saturated fat and all outcomes was “very low.” The certainty of associations of trans fat with CHD outcomes was “moderate” and “very low” to “low” for other associations.In particular, the number of clinical guidelines is now both unmanageable and unfathomable.One 2005 audit of a 24 hour medical take in an acute hospital, for example, included 18 patients with 44 diagnoses and identified 3679 pages of national guidelines (an estimated 122 hours of reading) relevant to their immediate care.27 Evidence based medicine is, increasingly, a science of marginal gains—since the low hanging fruit (interventions that promise big improvements) for many conditions were picked long ago.For example, the incidence of arthroscopic washout of the knee joint, whose benefits are unproved except when there is a known loose body, varies from 3 to 48 per 100 000 in England.13 More fundamentally, many who support evidence based medicine in principle have argued that the movement is now facing a serious crisis (box 1).14 15 Below we set out the problems and suggest some solutions.
The first problem is that the evidence based “quality mark” has been misappropriated and distorted by vested interests.Authors whose submissions do not comply with the Instructions for Authors will have their papers un-submitted so that the file(s) may be adjusted accordingly.Directions regarding the necessary corrective actions will be provided in an email to the corresponding author at the time the paper is un-submitted.carries a manuscript submission fee* of .00 USD upon submission of each new manuscript.Upon payment, you will be provided a Manuscript Submission Code, and will be prompted to enter this information when uploading your files to our peer-review system.Objective To systematically review associations between intake of saturated fat and trans unsaturated fat and all cause mortality, cardiovascular disease (CVD) and associated mortality, coronary heart disease (CHD) and associated mortality, ischemic stroke, and type 2 diabetes. Data sources Medline, Embase, Cochrane Central Registry of Controlled Trials, Evidence-Based Medicine Reviews, and CINAHL from inception to , supplemented by bibliographies of retrieved articles and previous reviews.