The field and its boundaries

Luigi Naldi

Evidence-based medicine represents the best way of linking and integrating clinical research with clinical practice.1-6 The results of clinical research should inform clinical practice. Ideally, whenever a clinical question has no satisfactory answer it should be addressed by clinical research. Since clinical questions are innumerable and resources are limited, the process needs some control, and priorities should be set using explicit and verifiable criteria.7-9 The public and purchasers have to be involved at this stage, and health needs and expectations in any given clinical area should be analysed and taken into account. In many instances, confirmatory studies are needed and systematic reviews can be used to summarise study results, or to explore results in specific subgroups with a view to further research. The results of clinical research should be applied back to individual patients in the light of their personal values and preferences. In the real world, forces other than those involved in such an ideal process often distort research priorities.10,11 For example, strong industrial and economical interests partly justify the lack of data on rare disorders, or on common disorders if they occur mainly in less developed countries. This book may help to identify the more urgent questions that lack a satisfactory answer by summarising for physicians (and patients) the best evidence available for the management of a large number of skin disorders. It may thus be a starting point for rethinking the clinical research priorities in patient-oriented dermatology.

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