Editorials

Evidence based medicine: what it is and what it isn't

BMJ 1996; 312 doi: http://dx.doi.org/10.1136/bmj.312.7023.71 (Published 13 January 1996) Cite this as: BMJ 1996;312:71
  1. David L Sackett,
  2. William M C Rosenberg,
  3. J A Muir Gray,
  4. R Brian Haynes,
  5. W Scott Richardson
  1. Professor NHS Research and Development Centre for Evidence Based Medicine, Oxford Radcliffe NHS Trust, Oxford OX3 9DU
  2. Clinical tutor in medicine Nuffield Department of Clinical Medicine, University of Oxford, Oxford
  3. Director of research and development Anglia and Oxford Regional Health Authority, Milton Keynes
  4. Professor of medicine and clinical epidemiology McMaster University, Hamilton, Ontario Canada
  5. Clinical associate professor of medicine University of Rochester School of Medicine and Dentistry, Rochester, New York, USA

    It's about integrating individual clinical expertise and the best external evidence

    Evidence based medicine, whose philosophical origins extend back to mid-19th century Paris and earlier, remains a hot topic for clinicians, public health practitioners, purchasers, planners, and the public. There are now frequent workshops in how to practice and teach it (one sponsored by the BMJ will be held in London on 24 April); undergraduate1 and postgraduate2 training programmes are incorporating it3 (or pondering how to do so); British centres for evidence based practice have been established or planned in adult medicine, child health, surgery, pathology, pharmacotherapy, nursing, general practice, and dentistry; the Cochrane Collaboration and Britain's Centre for Review and Dissemination in York are providing systematic reviews of the effects of health care; new evidence based practice journals are being launched; and it has become a common topic in the lay media. But enthusiasm has been mixed with some negative reaction.4 5 6 Criticism has ranged from evidence based medicine being old hat to it being a dangerous innovation, perpetrated by the arrogant to serve cost cutters and suppress clinical freedom. As evidence based medicine continues to evolve and adapt, now is a useful time to refine the discussion of what it is and what it is not.

    Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The …

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