What is the age of the concept of Evidence-Based Medicine (EBM)?

From the Guidelines

The concept of Evidence-Based Medicine (EBM) has its origins dating back to the mid-nineteenth century, but its modern form is approximately 30-35 years old. The idea of using empirical evidence to guide medical practice has historical roots that can be traced back centuries. However, the formal term and structured approach to EBM emerged in the early 1990s at McMaster University in Canada, led by Dr. Gordon Guyatt and colleagues 1.

Key Points

• The modern EBM movement represented a shift from traditional authority-based medicine toward systematic evaluation of research evidence to inform clinical decision-making 1.
• The philosophical foundations of using empirical evidence to guide medical practice can be traced back centuries, with significant developments in clinical epidemiology in the 1970s and 1980s laying crucial groundwork.
• EBM is a constantly evolving process; as more evidence becomes available, old tests and treatments are replaced with more accurate, powerful, effective, and safer ones 1.
• The ultimate goal of practice guidelines is to facilitate the translation of the most recent evidence into practice to improve patient care and outcomes 1. Some of the key aspects of EBM include:
• The integration of individual clinical expertise with the best available clinical evidence from systematic research 1.
• Asking answerable questions, searching for the best evidence, critically appraising the evidence, applying the evidence to individual patient care, and evaluating the process 1. Overall, while the concept of EBM has a long history, its modern form and structured approach are relatively recent developments, dating back to the early 1990s.

From the Research

History of Evidence-Based Medicine

The concept of Evidence-Based Medicine (EBM) has a long and evolving history.

• The term "evidence-based medicine" is relatively new, with its formal origin dating back to the mid-nineteenth century 2.
• However, the history of EBM goes back for centuries, with ancient historical or anecdotal accounts of what may be loosely termed EBM 3.
• The development of EBM can be divided into several eras, including the ancient era, the renaissance era, the transitional era, and the modern era 3.

Evolution of EBM

• The modern era of EBM began in the 1970s, with the advent of technology playing a significant role in its advancement 3.
• The phrase "evidence-based medicine" was first used in the medical literature less than 25 years ago, but the concept has become widely accepted and popular globally 4.
• EBM has evolved to incorporate not only evidence but also clinical expertise and patient values and preferences 4.
• The future of EBM is likely to involve the widespread use of clinical decision support systems and easily accessible evidence-based summaries 4.

Key Figures and Contributions

• Archibald Cochrane and David Sackett have made significant contributions to the development and dissemination of EBM 5.
• Their work has helped broaden discussions on the relationships between teaching and medical practice, and has played an important role in curriculum reforms and training models and practices in health care 5.
• The concept of EBM has been influenced by various philosophers and researchers, including Bruno Latour, who has argued that evidence in clinical decision making is relentlessly situated and contextual 6.