Evidence is in the eye of the beholder: The case of the 2016 draft NICE guidelines for low back pain

As the paradigm of evidence-based medicine reaches its adolescence, it is appropriate to acknowledge how the systematic surveying of evidence on a particular clinical topic has constituted a positive advancement in healthcare decision makin. But for all the benefits rigorous review methods have to offer, we must remember that no matter how many controls we have in place to minimise bias from the process, ultimately the appraisal and synthesis of research remains a purely human endeavour and with that comes interpretation consistent with a particular, subjective world-view [2]. The recent publication of the UK’s National Institute for Health and Care Excellence (NICE) new draft guidelines for the management and treatment of low back pain and sciatica offers a prime example (https://www.nice.org.uk/). Unlike the 2009 guideline which recommended a course of acupuncture, the updated draft, published in March 2016, recommended against acupuncture [3].