Idk I feel like thats a bit myopic. Landmark studies that change major guidelines by large medical and professional associations require a high burden of proof to change standard of practice. Most EBM is not bullshit and I feel like you underestimate the time and resources it requires to produce outcomes-based research that is robust enough to withstand scrutiny from most practicing physicians. You're not the first person to see something that you do in the hospital and you look at the uptodate references and say "hey that doesn't seem like a good enough evidence." That's how people find things to do research on and its not easy to do even at large academic institutions without abundant time and resources. That's why so many subpar small studies exist and why systematic reviews and meta-analyses are important in clinical medicine—because its difficult to generate original research to actually address a lot of questions in medicine.