Evidence-based medicine is a medical movement based upon the application of the scientific method to the whole body of medical practice, including long-established existing medical traditions that may never have been subjected to systematic scrutiny. According to the Centre for Evidence-Based Medicine, “Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”
Professor Archie Cochrane was a British medical researcher whose book Effectiveness and Efficiency: Random Reflections on Health Services (1972) and subsequent advocacy caused increasing acceptance of the evidence-based medicine concept. Cochrane’s work was honoured through the naming of centres of evidence-based medical research – Cochrane Centres – and an international organisation – the Cochrane Collaboration.
Using techniques from science, engineering and statistics, such as meta-reviews of the existing literature, risk-benefit analysis and randomized controlled trials, it aims for the ideal that all doctors should make “conscientious, explicit, and judicious use of current best evidence” in making decisions about the care of individual patients.
Practising evidence-based medicine implies not only clinical expertise, but expertise in retrieving, interpreting, and applying the results of scientific studies, and in communicating the risks and benefit of different courses of action to patients.
Critics of evidence-based medicine point out that doctors were doing this already, that good evidence is often deficient in many areas, that lack of evidence of benefit and lack of benefit are not the same, and that the more data are pooled and aggregated the more difficult it is to compare the patients in the studies with the one in front of you.
For all its problems, evidence-based medicine has very successfully demoted the ex cathedra statement of the “medical expert” to the least valid form of evidence–all experts must sprinkle their pronouncements with references to the relevant literature.
