Intended for healthcare professionals


Evidence based medicine has come a long way

BMJ 2004; 329 doi: (Published 28 October 2004) Cite this as: BMJ 2004;329:990
  1. Gordon Guyatt, professor (,
  2. Deborah Cook, professor,
  3. Brian Haynes, professor
  1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada L8N 3Z5

    The second decade will be as exciting as the first

    Evidence based medicine seeks to empower clinicians so that they can develop independent views regarding medical claims and controversies. Although many helped to lay the foundations of evidence based medicine,1 Archie Cochrane's insistence that clinical disciplines summarise evidence concerning their practices, Alvan Feinstein's role in defining the principles of quantitative clinical reasoning, and David Sackett's innovation in teaching critical appraisal all proved seminal. The term evidence based medicine,2 and the first comprehensive description of its tenets, appeared little more than a decade ago. In its original formulation, this discipline reduced the emphasis on unsystematic clinical experience and pathophysiological rationale, and promoted the examination of evidence from clinical research. Evidence based medicine therefore required new skills including efficient literature searching and the application of formal rules of evidence in evaluating the clinical literature.

    Important developments in evidence based medicine over the subsequent decade included the increasing popularity of structured abstracts3 and secondary journals summarising …

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