The other important corollary of the evidence hierarchy is that absence of RCT evidence does not mean we become paralysed into doing nothing.22 Failure to find any RCTs for the treatment of necrobiosis lipoidica does not mean that we tell our patients to go away because there is no treatment. We may come across a well-conducted case series, a convincing case report, or trust the anecdotal evidence of a senior colleague - all of forms of evidence that are entirely appropriate to use in the absence of better sources. It is just that for many years, the evidence hierarchy has been used the other way around in practice - starting with asking a colleague and usually ending up by referring to an out-of-date textbook.
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