Intended for healthcare professionals

Medical Milestones

Evidence based medicine: increasing, not dictating, choice

BMJ 2007; 334 doi: (Published 04 January 2007) Cite this as: BMJ 2007;334:s10
  1. Kay Dickersin, professor kdickers@jhsph.edu1,
  2. Sharon E Straus, associate professor2,
  3. Lisa A Bero, professor3
  1. 1Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
  2. 2Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3Department of Clinical Pharmacy and Institute for Health Policy Studies, University of California, San Francisco, USA

    The systematic synthesis of evidence is the foundation of all medical discoveries and of good clinical practice

    Evidence based medicine is healthcare practice that is based on integrating knowledge gained from the best available research evidence, clinical expertise, and patients' values and circumstances. It is curious, even shocking, that the adjective “evidence based” is needed. The public must wonder on what basis medical decisions are made otherwise. Is it intuition? Magic? The public must also wonder what happens to the research evidence in which they have invested—either directly through taxes or indirectly through buying drugs and other medical products—if it is not guiding clinical practice.

    How could something so intuitively obvious to lay people not be similarly viewed by clinicians? And how could this medical milestone be so misunderstood by some? Critics of evidence based medicine worry that it dictates a single “right” way to practise, despite differences among patients; that some self appointed group of “experts” will declare only one type of study to be useful; or that healthcare decisions will be made solely on the basis of costs and cost savings. Giving a name to evidence based medicine and, now, awarding it milestone status could help everyone to realise that it is about making decisions that are based on the best available evidence, not dictating what clinicians do.

    Establishing a modern milestone

    The term “evidence based medicine” was coined in 1991 by a group at McMaster University, Ontario. It arose from a confluence of events and changes in our culture. These included a growing recognition that:

    • The systematic synthesis …

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