Evidence-Based Decision Making in Small Animal Therapeutics Deborah T. Kochevar, DVM, PhD a, * , Virginia Fajt, DVM, PhD b a Professional Programs, Dean’s Office, College of Veterinary Medicine and Biomedical Sciences, 4461 Texas A&M University, College Station, TX 77843–4461, USA b Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, 4466 Texas A&M University, College Station, TX 77843–4466, USA T he most modest goal of any therapeutic intervention is to ‘‘do no harm.’’ We hope to achieve far more than that through rational therapies sup- ported by sound clinical reasoning, scientific evidence, and an under- standing of risk management. Evidence-based decision making (EBDM) has emerged in the health sciences as a means to advance these therapeutic best practices. Technology has greatly enhanced the ability of clinicians and patients to access the scientific literature and to become well informed. As a consequence, clinicians can and must stay current or risk making poor decisions that clients may challenge. This risk is greatest when it comes to therapeutic decisions that require administration or prescription of drugs. Unedited drug information readily available to clients via the Internet ensures that physicians and veterinar- ians are going to be faced with questions and suggestions about their therapeutic choices. Veterinary pharmacologists and clinicians must understand and be pre- pared to defend why recommended treatments are safe and effective. At a time when outcomes assessment and accountability are increasingly re- quired of self-regulated professions, health professionals should feel especially ob- ligated to demonstrate the validity of their evidence-based clinical decision making. To do so, a number of skills must be in place. First, clinicians must be able to frame relevant answerable clinical questions. Although veterinarians are taught to define clinical problems to develop differential diagnoses, we often do not ask well-formulated questions about clinical outcomes. The necessary skills following on the first are the ability to identify and then critically appraise external evidence that informs the clinical question. It is here that the work of EBDM is largely accomplished. The validity and importance of information sour- ces, the fundamentals of clinical trial and experimental design, and the application of statistics to evidence appraisal must be understood. In veterinary medicine, limited availability of high-quality clinical data confounds this critical appraisal *Corresponding author. Tufts Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536, USA. E-mail address: deborah.kochevar@tufts.edu (D.T. Kochevar). 0195-5616/06/$ – see front matter ª 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.cvsm.2006.06.001 vetsmall.theclinics.com Vet Clin Small Anim 36 (2006) 943–959 VETERINARY CLINICS SMALL ANIMAL PRACTICE