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Rapid response to:

Editorials

Evidence based medicine and the medical curriculum

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1253 (Published 24 September 2008) Cite this as: BMJ 2008;337:a1253

Rapid Response:

The popularity of EBM is proportional to the failures of medicine itself

Since the term Evidence-Based Medicine (EBM) was created in the early
1990s, the adjective “Evidence-Based” has spread to various sectors of
science and humanities, e.g. sociology, psychology, education, crime
prevention, history, etc. It is however in medicine that the adjective has
met with its greatest popularity.

Let us first have a look at the definition of EBM given in 1996 by
some of its creators: “Evidence based medicine is the conscientious,
explicit, and judicious use of current best evidence in making decisions
about the care of individual patients. The practice of evidence based
medicine means integrating individual clinical expertise with the best
available external clinical evidence from systematic research” [1].

As already pointed out by others [2], such a definition is so broad
that it could indeed be an accurate definition of modern medicine itself,
all the more since the definition of EBM was refined over the years, and
it now integrates the four basic principle of medical ethics, i.e.
autonomy, beneficence, non-maleficence and justice [3], via the use of
words such as patients’ values and preferences, balance between benefits
and harms, costs and resource utilisation [4]. In the EBM world the four
ethical principles now determine whether a recommendation should be graded
strong or weak [5].

Who could possibly be opposed to a medical practice that would use
the best scientific evidence wisely, and ethically?

In our view, the most likely explanation for the popularity of EBM
is the very fact that its scope is so broad that it is nicely suited to
compensate for many failures and irrationalities within clinical practice,
and health care systems [5]. Otherwise it would not have been deemed
necessary to create this "new" term: the already existing term "medicine"
(which already means all what EBM is supposed to mean) would have sufficed
for most of us. Thus viewed, the popularity of EBM is likely to
proportional to the failures of medicine itself.

References:

1) Sackett DL, Rosenberg WC, Muir-Gray JA, Haynes RB, Richardson WS.
Evidence based medicine: what it is and what it isn't. BMJ 1996; 312: 71-
2.

2) Sehon SR, Stanley DE. A philosophical analysis of the evidence-
based medicine debate. BMC Health Serv Res 2003; 3:14.

3) Gillon R. Medical ethics: four principles plus attention to scope.
BMY 1994; 309:184-8.

4) Straus SE, Richardson WS, Glasziou P, Haynes RB. Evidence-Based
Medicine. 3rd edition, 2005.

5) Atkins D, Best D, Briss PA et al; GRADE Working Group. Grading
quality of evidence and strength of recommendations. BMJ 2004; 328:1490.

6) Raspe H. [Evidence-based medicine: popular nonsense, old wine in
new bottles or current necessity?] Z Arztl Fortbild 1996; 90:553-62
[Article in German].

Competing interests:
None declared

Competing interests: No competing interests

26 March 2010
Joseph C Watine
consultant, laboratory medicine
hôpital de Rodez, France