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[(concl)-8(usions)-317.4(can)-316.6(be)-320.1(arbitrarily)-320.1(used)-322.2(to)-319.1(develop)-315.4()45(cookbook)51.2()]TJ 0 -1.1174 TD [(approaches)-332.2(to)-319.1(medicine)-330.6(\(as)-321(addressed)-329.8(by)-319(Sackett\).)-326.8(The)-328.2(aim)]TJ 0 -1.1116 TD [(of)-353.5(EBM)-352(is)-353.5(to)-353.7(create)-351.2(a)-353.6(logical)-356(structure)-352.1(that)-357.2(can)-351.2(maintain)-352.6(a)]TJ T* [(productive)-359.2(and)-350(balanced)-359.2(working)-354.3(relationship)-355.7(among)-353.5(these)]TJ 0 -1.1174 TD [(three)-261.4(components.)-259.9(Although)-257.6(this)-257.9(is)-255.6(the)-258(ideal,)-259.2(it)-255.9(is)-255.6(not)-256.9(always)]TJ 0 -1.1116 TD [(the)-338.7(reality.)]TJ 1.0137 -1.1116 TD [(EBM,)-528.2(as)-527.3(with)-523.9(any)-528.6(idea,)-528.7(can)-524(be)-527.5(abused)-527.1(and)-528.6(executed)]TJ -1.0137 -1.1116 TD [(poorly)-6.7(.)-366.3(Many)-369.3(critics)-367.3(of)-370.8(EBM)-369.3(rightly)-370.9(point)-368.6(out)-366.3(that)-368.7(health-)]TJ 0 -1.1174 TD [(care)-301.6(management)-300.5(and)-292.4(third-party)-301.6(payers)-296.7(erroneously)-296.6(equate)]TJ 0 -1.1116 TD [(a)-457.3(lack)-456.1(of)-457.2(evidence)-462.9(with)-454.8(lack)-456.1(of)-457.2(effectiveness)-463.4(in)-451.6(order)-455.9(to)]TJ T* [(restrict)-460.5(patient)-459.7(care.)-460.5(In)-457.2(addition,)-457.3(these)-462.8(third-party)-457.1(entities)]TJ 0 -1.1174 TD [(often)-369.6(use)-361.4(the)-361.7(moniker)-367.3(of)-359.3(EBM)-363.5(to)-365.2(justify)-365(the)-361.7(imposition)-363.9(of)]TJ 0 -1.1116 TD [(guidelines)-387.9(or)-382.3(procedures)-388.6(on)-382.3(physicians.)-385.3(This)-385.7(is,)-379.9(of)-388.1(course,)]TJ T* [(diametrically)-406.7(opposed)-400.3(to)-394(the)-396.3(principles)-405.2(of)-393.8(EBM.)-401.5(In)-393.8(EBM,)]TJ 0 -1.1174 TD [(the)-430.8(physician,)-424.7(not)-429.7(a)-422.7(third)-426.2(party,)-424.9(is)-428.4(the)-425.1(one)-424.9(who)-430.4(applies)-424.8(a)]TJ 0 -1.1116 TD [(critical)-306.5(appraisal)-307.2(of)-301.7(the)-304.1(evidence)-301.6(to)-301.8(his)-302.7(or)-301.7(her)-298.2(patient.)-307.6(EBM)]TJ T* [(does)-351(require)-344.2(discipline)-347.7(on)-347.8(the)-344.4(part)-345.5(of)-347.8(the)-344.4(physician)-346.4(to)-347.9(base)]TJ 0 -1.1174 TD [(clinical)-329.6(decisions)-328.9(on)-324.7(the)-321.4(best)-328(evidence,)-328.1(but)-326(it)-325(does)-322.2(not)-326(give)]TJ 0 -1.1116 TD [(license)-408.7(to)-399.7(third)-403.1(parties)-401.7(to)-399.7(supplant)-407.5(the)-402(physicians)-400.2(clinical)]TJ T* [(expertise)-307.2(with)-299.3(policy.)-299.4(Again,)-299.1(it)-296.2(is)-301.6(a)-296(common)-298.2(misconcept)-10(ion)]TJ T* [(that)-380.2(EBM)-380.8(devalues)-375.1(clinical)-381.4(expertise.)-379.7(By)-377.6(making)-377.8(the)-379(rela-)]TJ 0 -1.1174 TD [(tionship)-343.1(between)-346.3(the)-344.4(physicians)-342.6(expertise)-347.5(and)-338.5(the)-344.4(best)-339.6(ev-)]TJ 0 -1.1116 TD [(idenc)-8(e)-457.3(clearer,)-465.1(EBM)-467.2(ensures)-458.9(that)-466.6(the)-459.6(value)-463(of)-462.9(individual)]TJ T* [(patient)-309.9(needs,)-304.8(physician)-306.1(expertise,)-304.9(and)-309.7(best)-299.3(evide)-8(nce)-305.1(are)-305.1(all)]TJ 0 -1.1174 TD [(accounted)-343(for)-331.5(in)-330.6(the)-338.7(clinical)-335.4(decision.)]TJ 1.0137 -1.1116 TD [(Some)-404.1(critics)-401.9(call)-398.7(for)-400.7(the)-402(development)-403(of)-399.6(an)-400.8()50.8(evidence-)]TJ -1.0137 -1.1116 TD [(informed)-345.3(practice)48.6()-340.9(t)0(o)-342.1(counter)-338.4(the)-344.4(problem)-338.5(of)-342(EBM)-340.5(misap-)]TJ 0 -1.1174 TD (plication.)Tj 7.3823 0 0 6.5614 350.192 355.918 Tm (12)Tj 9.843 0 0 9.843 362.2676 352.5164 Tm [(However,)-476(as)-475.5(Sackett)-472.1(and)-476.8(others)-474.2(have)-473.3(already)]TJ -4.9994 -1.1116 TD [(expla)-8(ined,)-475.7(EBM)-478.7(is)-474.4(already)-483.6(a)-474.6(revolution)-479.1(against)-476.6(such)-477.7(au-)]TJ T* [(thorit)-7(ative)-301.8(tyrannies.)-303.7(The)-305.2(fact)-306.3(that)-299.6(people)-302.8(and)-304(organizations)]TJ T* [(misuse)-279.4(and)-280.9(misrepresent)-282.7(EBM)-277.1(is)-278.6(not)-279.9(a)-273(reason)-279.4(to)-278.8(abandon)-280.8(it,)]TJ 0 -1.1174 TD [(or)-255.6(even)-248.6(modify)-249.8(it.)-253.6(EBM)-248.3(already)-253.2(allows)-256.4(for)-250.9(clinical)-249(decisions)]TJ 0 -1.1116 TD [(to)-238.5(be)-233.7(made)-238.3(in)-238.5(the)-235(absence)-236.8(of)-238.3(high-quality)-239.5(evidence,)-235.9(and)-240.6(does)]TJ T* [(not)-337.5(equate)-332.8(a)-336.3(lack)-335.2(of)-336.2(evidence)-336.1(with)-333.8(a)-336.3(lack)-335.2(of)-330.5(efcacy.)]TJ 1.0137 -1.1174 TD [(The)-431.9(evidence)-434.1(base)-427(for)-429.5(acupuncture)-431.6(as)-429.4(a)-428.5(therapeutic)-431.8(in-)]TJ -1.0137 -1.1116 TD [(tervention)-255.6(capable)-260.2(of)-249.8(treating)-259.2(many)-248.7(causes)-257.4(and)-252.1(types)-254.3(of)-255.6(pain)]TJ T* [(is)-560.8(strong,)]TJ 7.3823 0 0 6.5614 352.1763 258.2928 Tm (13)Tj 9.843 0 0 9.843 365.0456 253.9275 Tm [(and)-557.4(evidence)-555(that)-558.8(it)-555.4(can)-558.6(treat)-555.2(many)-559.7(of)-555.1(the)]TJ -5.2816 -1.1174 TD [(complex)-443.4(diseases)-443.8(it)-440.2(is)-434.1(purported)-443.1(to)-440.1(treat)-440(is)-439.9(emergent.)]TJ 7.3823 0 0 6.5614 535.5211 247.3511 Tm [(14,1)-8.6(5)]TJ 9.843 0 0 9.843 313.0582 231.9873 Tm [(The)-334(globalization)-335.2(of)-330.5(acupuncture)-333.7(and)-327(continued)-335(integration)]TJ 0 -1.1116 TD [(of)-365(acupuncture)-368.2(into)-361.8(the)-367.5(modern)-360.3(healthcare)-374.2(apparatus)-364.6(make)]TJ 0 -1.1174 TD [(critical)-513.9(the)-499.9(need)-507.8(to)-503.4(establish)-507.6(a)-509.1(comprehensive)-509.7(biological)]TJ 0 -1.1116 TD [(model)-388.2(of)-382.3(acupuncture.)-388.9(However,)-389.6(basic)-387.9(questions)-385.3(of)-382.3(mech-)]TJ T* [(anism)-491.6(remain)-494.1(unanswered,)-496.7(and)-488.3(signicant)-491.4(research)-497(prob-)]TJ T* [(lems)-651.8(need)-646.1(to)-647.4(be)-642.7(solved)-652.8(before)-648.2(such)-644.7(a)-647.3(model)-647.4(can)-645(be)]TJ 0 -1.1174 TD (realized.)Tj 7.3823 0 0 6.5614 346.9038 170.5889 Tm (16)Tj 9.843 0 0 9.843 358.2424 166.2236 Tm [(In)-399.6(addition,)-399.7(the)-396.3(eld)-403(is)-399.6(largely)-396.2(operating)-404.1(under)]TJ -4.5905 -1.1116 TD [(the)-459.6(same)-462.8(sort)-459.3(of)-457.2(authoritarian)-461.8(expert-base)-10.9(d)-456.1(medicine)-463(that)]TJ T* [(EBM)-340.5(seeks)-335.8(to)-330.6(overthrow.)]TJ 1.0137 -1.1174 TD [(EBM)-542.1(can)-547(provide)-538.9(for)-544.7(acupuncture)-546.8(physicians)-543.1(and)-540.1(re-)]TJ -1.0137 -1.1116 TD [(searchers)-250.3(a)-244.2(single,)-247.4(well-dened)-246.9(goal.)-245.3(This)-247.4(clearly)-247.6(articulated)]TJ T* [(and)-649.6(established)-649.2(objective)-653.1(could)-646.1(unite)-646.3(like-minded)-649.6(acu-)]TJ 0 -1.1174 TD [(puncture)-333.8(physicians)-335.8(and)-332.8(researchers.)-337.7(It)-330.6(could)-329.3(also)-333.8(unite)-335.2(the)]TJ 0 -1.1116 TD [(acupu)-7.8(ncture)-331.6(eld)-333.8(with)-333.8(other)-335.1(healthcare)-339.6(disciplines)-337.1(working)]TJ T* [(toward)-417.7(the)-407.8(same)-416.7(objective.)-414.6(This)-408.7(will)-414.6(allow)-411(the)-413.5(sharing)-411.9(of)]TJ 0 -1.1174 TD [(information)-435.3(and)-430.7(foster)-433.9(collegiality)-437.9(between)-432.7(acupuncturists)]TJ 0 -1.1116 TD [(and)-459.5(their)-456.2(biomedical)-459.6(counterparts.)-457.9(EBM)-455.7(can)-454.9(be)-452.6(a)-457.3(banner)]TJ /F4 1 Tf 8.9663 0 0 8.9663 62.022 749.6502 Tm (806)Tj 50.4379 0 TD (GODWIN)Tj ET endstream endobj 4 0 obj <> endobj 5 0 obj <>/Font<>/ProcSet[/PDF/Text]>> endobj 6 0 obj <>stream /GS1 gs BT /F5 1 Tf 9.843 0 0 9.843 59.7543 725.1588 Tm 0 0 0 1 k 0 Tc 0 Tw [(under)-427.1(which)-428.1(those)-427.1(wishing)-429.1(to)-428.5(develop)-424.9(acupuncture)-431.6(into)-425.1(a)]TJ 0 -1.1174 TD [(fully)-334(accepted)-343.1(therapeutic)-333.9(interventio)-9.2(n)-329.4(can)-333.9(rally.)]TJ /F4 1 Tf 8.9663 0 0 8.9663 59.7543 686.7778 Tm [(Scientic)-335.1(Research)-334.8(Is)-336.7(Imperative)]TJ /F5 1 Tf 9.843 0 0 9.843 69.7323 670.3369 Tm [(EBM)-288.7(relies)-291.2(on)-290.2(the)-286.8(machinery)-291.2(of)-290.2(a)-290.2(mature)-286.7(normal)-291.3(science)]TJ -1.0137 -1.1116 TD [(to)-474.6(provide)-469.7(demonstrable,)-476.4(repeatable,)-475.5(and)-471(dependable)-476.6(evi-)]TJ T* [(dence)-239.4(for)-239.4(the)-240.7(use)-234.7(of)-238.3(any)-240.6(given)-237.2(therapeutic)-241.8(intervention.)-244.1(Only)]TJ 0 -1.1174 TD [(practitioners)-548(operating)-548.1(a)-543.7(science)-547.9(described)-549(by)-537.9(Kuhn)]TJ 7.3823 0 0 6.5614 281.6503 641.877 Tm (1)Tj 9.843 0 0 9.843 290.6645 637.455 Tm (as)Tj /F8 1 Tf -23.4593 -1.1116 TD (normal)Tj /F5 1 Tf 3.2485 0 TD 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261.6377 549.8077 Tm (Solutions)Tj -20.5103 -1.1116 TD [(must)-345.4(be)-343.2(found)-345.3(and)-338.5(developed)-347.6(into)-344.5(sound)-339.4(scientic)-347.5(theories)]TJ 0 -1.1174 TD [(that)-443.6(can)-437.6(be)-435.3(rened)-440.7(through)-439.8(repeated)-439.8(research)-445.2(before)-440.8(acu-)]TJ 0 -1.1116 TD [(puncture)-270.4(can)-264.8(enjoy)-266(the)-263.8(benets)-263.2(of)-267.1(a)-261.4(normal)-268.3(science.)-263.4(The)-264.9(de-)]TJ T* [(velopment)-215.3(and)-211.8(maintenance)-221(of)-209.5(an)-210.7(acupuncture)-218.5(evidence)-215.2(base)]TJ 0 -1.1174 TD [(are)-276.3(the)-275.3(most)-270.5(important)-271.9(challenge)-279.8(posed)-271.4(by)-272.9(EBM)-271.4(and)-275.2(are)-270.5(the)]TJ 0 -1.1116 TD [(key)-471(to)-463.1(acupunctures)-473.9(future)-462.9(in)-468.9(the)-465.4(modern)-469.7(world.)-464.9(It)-468.8(is)-462.9(a)]TJ T* [(challenge)-279.8(that)-276.5(the)-281.1(eld)-276.2(must)-270.5(embrace)-284.3(whole-heartedly)-281.6(with-)]TJ 0 -1.1174 TD [(out)-274.1(asking)-266.9(for)-268.2(concessions.)-277.8(Although)-269.1(creative)-272.9(solutions)-274.9(may)]TJ 0 -1.1116 TD [(need)-214.1(to)-209.7(be)-210.7(found,)-210.5(acupuncturists)-214.7(must)-212.9(be)-210.7(willing)-210.7(to)-215.4(be)-210.7(held)-207.3(to)]TJ T* [(the)-188.9(same)-186.3(standards)-190.5(as)-187.5(other)-191.1(healthcare)-189.8(professionals.)-192.5(Much)-185(of)]TJ T* [(the)-269.5(groundwork)-265.3(has)-269.2(already)-270.5(been)-265.9(done)-264.8(to)-267.3(move)-266(acupuncture)]TJ 0 -1.1174 TD [(in)-250(the)-252.3(right)-253.4(direction.)-252.2(However,)-257.1(much)-248.7(work)-252.9(remains.)]TJ 1.0137 -1.1116 TD [(Wo)18.6(rk)20.9(in)20.7(g)-323.6(t)0(o)20.7(w)0(a)18.8(r)0(d)-307.4(e)0(v)19.7(i)0(d)20.7(e)0(n)13.9(c)0(e)18.5(-)0(b)20.9(a)0(s)19.9(e)0(d)-308.6(a)0(c)18.5(u)0(p)15.1(u)0(n)20.8(c)0(t)19.5(u)0(r)20.9(e)-319(pr)20.9(ov)15.1(id)20.7(es)-308.4(th)20.7(e)]TJ -1.0137 -1.1116 TD 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[(what)-334.9(will)-334(the)-338.7(modern)-331.5(acupuncture)-339.4(community)-336.3(respond?)]TJ 1.0137 -1.1174 TD [(If)-393.8(the)-396.3(acupuncture)-397(profession)-397.8(can)-397.3(redirect)-398.4(at)-395.1(least)-393.8(some)]TJ -1.0137 -1.1116 TD [(signicant)-330.2(portion)-324.7(of)-324.7(its)-325.9(intellectual)-329.7(and)-321.2(nancial)-329.2(resources)]TJ 25.504 67.9184 TD [(toward)-365.8(meeting)-368.6(the)-361.7(clearly)-368.5(dened)-365.9(objectives)-366(of)-365(evidence-)]TJ 0 -1.1174 TD [(based)-266.8(medicine,)-270.7(a)-261.4(comprehensive)-267.8(biological)-267.3(model)-267.2(could)-260.2(be)]TJ 0 -1.1116 TD [(devel)-8(oped.)-417.9(With)-421.6(such)-420.1(a)-417(model)-422.7(supported)-419.9(by)-416.9(a)-422.7(robust)-421.2(sci-)]TJ T* [(entic)-394.9(evidence)-393.7(base,)-395.9(acupuncture)-391.3(becomes)-398.1(a)-388.2(vital)-393(part)-391.6(of)]TJ T* [(modern)-354.6(healthcare.)-348.8(Current)-349.8(epistemologic)-353.4(barriers)-350.8(dividing)]TJ 0 -1.1174 TD [(acupu)-7.8(ncturists)-270.2(from)-270.5(other)-271.7(healthcare)-276.2(professionals)-275.5(would)-271.4(be)]TJ 0 -1.1116 TD [(eroded.)-277.3(Acupuncturists)-272(would)-277.2(be)-268.3(able)-271.8(to)-273(reap)-271.6(the)-275.3(benets)-269(of)]TJ T* [(resear)-9.8(ch)-291.3(and)-298.2(developments)-300.2(in)-296.1(other)-294.8(elds)-300.2(of)-295.9(science,)-298(taking)]TJ 0 -1.1174 TD [(advan)-7.8(tage)-335.2(of)-330.5(new)-333.6(technologies)-339.5(and)-332.8(new)-333.6(theories.)]TJ 1.0137 -1.1116 TD [(Ac)18.8(up)15.1(un)20.8(ct)19.5(ur)20.9(e)-399.7(p)0(h)20.8(y)0(s)21(i)0(c)19.6(i)0(a)19.6(n)0(s)-387.9(a)0(n)19.7(d)-398.5(re)19.7(se)19.9(ar)19.7(ch)19.7(er)19.7(s)-398.3(i)0(n)20.7(t)0(e)19.6(r)0(e)14(s)0(t)20.9(e)0(d)-383.5(i)0(n)-388.2(d)0(e)19.7(-)]TJ -1.0137 -1.1116 TD 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[(fo)15.1(r)-358.2(h)0(i)20.7(g)0(h)20.8(e)0(r)-354.7(e)0(d)19.7(u)0(c)19.7(a)0(t)19.5(i)0(o)20.7(n)0(a)13.9(l)-358.3(an)19.7(d)-358.2(p)0(r)15.1(o)0(f)20.9(e)0(s)19.9(s)0(i)20.9(o)0(n)15.1(a)0(l)-349.1(s)0(t)20.9(a)0(n)19.7(d)0(a)19.7(r)0(d)15.1(s)-358(ac)18.5(ro)20.9(ss)-353.2(th)20.7(e)]TJ T* [(e)14.1(ld)20.7(.)-360.5(T)0(h)19.6(e)-359.4(re)19.7(se)14.1(ar)19.7(ch)-348.9(th)20.7(at)-354.8(is)-347.7(be)19.7(in)15(g)-358.2(d)0(o)20.8(n)0(e)-348.9(i)0(s)-353.5(n)0(o)20.8(t)-364.1(n)21(di)20.7(ng)-347.8(it)14.8(s)-358(w)0(a)18.8(y)]TJ 0 -1.1174 TD [(in)15(to)-359.4(th)20.7(e)-370.9()0(e)19.8(l)0(d)-359.4(a)0(t)-360.6(e)0(i)19.6(t)0(h)20.7(e)0(r)-360.4(o)0(f)-359.3(t)0(h)20.7(e)0(s)19.9(e)-370.9(le)19.5(ve)19.7(ls)15.1(.)-366.3(C)0(o)19.8(l)0(l)14.8(e)0(g)19.7(e)-365.1(cu)13.9(rr)20.9(ic)19.6(ul)20.7(a)-370.9(a)0(r)19.7(e)]TJ 0 -1.1116 TD 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[(m)-18.8(e)-.4(e)-18.8(t)-529.1(t)-18.8(h)1.9(e)-539.4(n)-18.8(ee)-18.8(ds)-538.1(o)-18.8(f)-527.8(a)-533.7(m)-18.8(od)-18.8(er)-18.8(n)-527.8(h)-18.8(ea)-18.8(lt)-18.8(hc)-18.8(ar)-18.8(e)-523.2(s)-18.8(ys)-18.8(te)-18.8(m)-524.5(o)-18.8(pe)-18.8(ra)-18.8(ti)-18.8(ng)]TJ T* -.0198 Tc [(u)-19.8(n)-4.7(d)-19.8(e)-.1(r)-343.4(a)-19.8(n)-334.2(e)-19.8(vi)-19.8(de)-19.8(nc)-19.8(e-)-19.8(ba)-19.8(s)-5.7(e)-19.8(d)-334.2(m)-19.8(ed)-19.8(ic)-19.8(in)-19.8(e)-334.2(p)-19.8(ar)-19.8(ad)-19.8(ig)-19.8(m.)]TJ /F4 1 Tf 8.9663 0 0 8.9663 313.0582 416.296 Tm 0 Tc [(Author)-338.7(Disclosure)-336.7(Statement)]TJ /F5 1 Tf 9.843 0 0 9.843 323.0361 399.855 Tm [(No)-337.1(competing)-336.3(nancial)-334.9(interests)-334.7(exist.)]TJ /F4 1 Tf 8.9663 0 0 8.9663 313.0582 376.1574 Tm (References)Tj /F5 1 Tf 9.2951 0 0 9.2951 317.707 360.1133 Tm [(1.)-500.4(Kuhn)-368.1(TS.)-358.9(The)-366.4(Structure)-363.8(of)-362.5(Scientic)-365.6(Revolutions.)-367.9(4th)-365.8(ed.)]TJ 1.2503 -1.1284 TD 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