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Editorials

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;329:990

Rapid Response:

The Use and Misuse of Evidence-Based Medicine

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

01 November 2004
Benjamin G. Druss
Associate Professor of Health Policy
Rollins School of Public Health