Celebrating the “silver anniversary” of evidence-based medicine

The Lancet commemorates evidence-based medicine a quarter century on

Evidence-based medicine (EBM) started as a movement in the early 1990s, in order to evaluate and in turn acquire a better empirical basis for the practice of medicine, explain Professor Benjamin Djulbegovic and Professor Gordon Guyatt in The Lancet.

Originally focused on critical appraisal, development of systematic reviews and clinical practice guildelines, these three areas coalesced as EBM evolved into the practice it is today.

“On the surface, EBM proposes a specific association between medical evidence, theory, and practice. [It] does not, however, offer a new scientific theory of medical knowledge, but instead has progressed as a coherent heuristic structure for optimising the practice of medicine, which explicitly and conscientiously attends to the nature of medical evidence,” write the authors.

“EBM has become essential for the training of young clinicians by stressing critical thinking and the importance of statistical reasoning and continuous evaluation of medical practice.”

It has contributed substantially to the improvement of the quality of research, the authors add.

EBM has three major tenets:

  1. An increasingly sophisticated hierarchy of evidence;
  2. The need for systematic summaries of the best evidence to guide care; and
  3. The requirement for considering patient values in important clinical decisions.

While there are some challenges that the approach faces, such as failure to publish and the place of evidence in the time of big data, “efforts are well underway in each of the problematic areas”, say Djulbegovic and Guyatt.

“Whatever the extent of future progress, EBM’s success in providing a framework for fully integrating research evidence into the delivery of health care, and raising awareness of the need for consideration of individual patient values and preferences, will remain enduring contributions to clinical medicine and related fields.”

Read the full article here: Progress in evidence-based medicine: a quarter century on

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