Evidence based medicine has come a long way
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7473.990 (Published 28 October 2004) Cite this as: BMJ 2004;329:990All rapid responses
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It is indeed extraordinary to note that the term “evidence-based
medicine” entered the scientific lexicon only a little more than a decade
ago (1). What has accounted for the remarkable spread of EBM, and what
are the implications of its broad and rapid diffusion?
The team that coined the term “evidence-based medicine” at first
considered using the phrase “scientific medicine,” but rejected it because
it implied that other approaches were by definition “unscientific.” (2)
However, critics have argued that the term “evidence-based medicine”
carries a similar moral valence and linguistic slipperiness. (3) Who
could argue against the notion of providing care that “integrat[es]
individual clinical expertise and the best external evidence?” (4)
Originally developed as a method for teaching medical residents, EBM is
being applied ever more broadly to the organization and delivery of
medical services.
Multiple stakeholders are now seeking to assume the mantle of
evidence-based medicine for purposes that often contradict its original
intent. Managers, equating lack of evidence with lack of effectiveness,
use it as a rationale for cutting services. Industry generates evidence
of questionable quality to promote its products. And medical researchers
come to believe that they hold a monopoly on the generation and
interpretation of evidence. Evidence-based medicine, developed as a means
of taming the unscientific and messy world of clinical practice, has
itself entered the unscientific and messy world of politics.(5)
Like any technology, evidence-based medicine carries risks and
benefits, like any technology, it can be used appropriately or
inappropriately. Overly inclusive definitions threaten to deprive the term
of meaning, and unchecked dissemination increases the risk of misuse. In
the past decade, evidence-based medicine has contributed much to how we
teach, deliver, and think about clinical services. In the coming decade,
we must continue to ensure that evidence-based medicine is not simply used
widely, but that that it is also used wisely.
REFERENCES
1. Guyatt G, Cook D, Hayned B. Evidence based medicine has come a
long way BMJ 2004; 329; 990-1.
2. Guyatt G. Preface. From Guyatt G and Rennie D. Users’ Guide to
the Medical Literature. Chicago, Ill American Medical Association, 2001,
P. xiv.
3. Sehon SR, Stanley DE.A philosophical analysis of the evidence-
based medicine debate. BMC Health Serv Res. 2003;3(1):14.
4. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS.
Evidence based medicine: what it is and what it isn't. BMJ.
1996;312(7023):71-2.
5. Rodwin MA. The politics of evidence-based medicine. J Health Polit
Policy Law. 2001;26(2):439-46.
Competing interests:
None declared
Competing interests: No competing interests
Evidence based medicine: old wine in new bottle?
The practice of medicine in different cultures and civilizations over
the ages has never been blind. The rationale for diagnosis and treatment
has always been based on evidence ranging from gut or spiritual feeling,
minimal anecdotal experience, to well controlled studies.
In contrast to earlier times when fewer studies were undertaken and
less proper scientific evidence was available, both the quality and volume
of current research into all aspects of medicine has multiplied
tremendously in scope and depth. This has resulted in the availability of
vast amounts of data that needs to be scrutinized, and the need to ensure
that the methodologies and the conduct of the studies themselves are
proper.
The concept of evidence based-medicine is not new. It has been with
us from the beginning of time. If something did not work, man has always
sought alternative and more effective solutions and this applies not only
to medicine but also to all aspects of human life from agriculture to
engineering. Man has based his practice on whatever evidence he could
gather, and in its absence he has resorted to what is next best – gut
feeling tempered by traditional, cultural and religious values.
The fact is that we are more scientific now than in the past, but we
would certainly be less scientific now than in the future. The only
rational action to pursue is base one’s practice on the best available
data at any one time and keep up-to-date with the new evidence that
emerges.
Professor Davendralingam Sinniah
Professor of Paediatrics
Penang Medical College,
4 Jalan Sepoy Lines,
10450 Penang, Malaysia
d.sinniah@pmc.edu.my
Competing interests:
None declared
Competing interests: No competing interests