5.9 KiB
| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Evidence-based medicine | 1/6 | https://en.wikipedia.org/wiki/Evidence-based_medicine | reference | science, encyclopedia | 2026-05-05T09:56:04.124595+00:00 | kb-cron |
Evidence-based medicine (EBM), sometimes known within healthcare as evidence-based practice (EBP), is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." The aim of EBM is to integrate the experience of the clinician, the values of the patient, and the best available scientific information to guide decision-making about clinical management. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients. The EBM Pyramid is a tool that helps in visualizing the hierarchy of evidence in medicine, from least authoritative, like expert opinions, to most authoritative, like systematic reviews. Adoption of evidence-based medicine is necessary in a human rights-based approach to public health and a precondition for accessing the right to health.
== Background, history, and definition == Medicine has a long history of scientific inquiry into the prevention, diagnosis, and treatment of human disease. In the 11th century AD, Avicenna, a Persian physician and philosopher, developed an approach to EBM that was mostly similar to current ideas and practises. The concept of a controlled clinical trial was first described in 1662 by Jan Baptist van Helmont in reference to the practice of bloodletting. Wrote Van Helmont:
Let us take out of the Hospitals, out of the Camps, or from elsewhere, 200, or 500 poor People, that have fevers or Pleuritis. Let us divide them in Halfes, let us cast lots, that one halfe of them may fall to my share, and the others to yours; I will cure them without blood-letting and sensible evacuation; but you do, as ye know ... we shall see how many Funerals both of us shall have... The first published report describing the conduct and results of a controlled clinical trial was by James Lind, a Scottish naval surgeon who conducted research on scurvy during his time aboard HMS Salisbury in the Channel Fleet, while patrolling the Bay of Biscay. Lind divided the sailors participating in his experiment into six groups, so that the effects of various treatments could be fairly compared. Lind found improvement in symptoms and signs of scurvy among the group of men treated with lemons or oranges. He published a treatise describing the results of this experiment in 1753. An early critique of statistical methods in medicine was published in 1835, in Comtes Rendus de l'Académie des Sciences, Paris, by a man referred to as "Mr Civiale". In 1990, Gordon Guyatt, then a young internal medicine residency coordinator at McMaster University, introduced a teaching method he initially termed "Scientific Medicine." This approach emphasized applying critical appraisal techniques directly to bedside clinical decision-making, building on the work of his mentor, David Sackett. However, the concept met resistance from colleagues, as it implied that existing clinical practices lacked scientific rigor, even though this was likely true. To address this, Guyatt rebranded the approach as "Evidence-Based Medicine", a term first formally introduced in a 1991 editorial in the ACP Journal Club. Although the name was coined in 1991, it took several years after and a concerted efforts of many other teams to define the foundations of this method. Although more popular in medicine, the concept of "evidence-based" is spreading to other disciplines, such as the humanities, and to languages other than English, albeit at a slower pace.
=== Clinical decision-making === Alvan Feinstein's publication of Clinical Judgment in 1967 focused attention on the role of clinical reasoning and identified biases that can affect it. In 1972, Archie Cochrane published Effectiveness and Efficiency, which described the lack of controlled trials supporting many practices that had previously been assumed to be effective. In 1973, John Wennberg began to document wide variations in how physicians practiced. Through the 1980s, David M. Eddy described errors in clinical reasoning and gaps in evidence. In the mid-1980s, Alvin Feinstein, David Sackett and others published textbooks on clinical epidemiology, which translated epidemiological methods to physician decision-making. Toward the end of the 1980s, a group at RAND showed that large proportions of procedures performed by physicians were considered inappropriate even by the standards of their own experts.
=== Evidence-based guidelines and policies ===
David M. Eddy first began to use the term 'evidence-based' in 1987 in workshops and a manual commissioned by the Council of Medical Specialty Societies to teach formal methods for designing clinical practice guidelines. The manual was eventually published by the American College of Physicians. Eddy first published the term 'evidence-based' in March 1990, in an article in the Journal of the American Medical Association (JAMA) that laid out the principles of evidence-based guidelines and population-level policies, which Eddy described as "explicitly describing the available evidence that pertains to a policy and tying the policy to evidence instead of standard-of-care practices or the beliefs of experts. The pertinent evidence must be identified, described, and analyzed. The policymakers must determine whether the policy is justified by the evidence. A rationale must be written." He discussed evidence-based policies in several other papers published in JAMA in the spring of 1990. Those papers were part of a series of 28 published in JAMA between 1990 and 1997 on formal methods for designing population-level guidelines and policies.