Introduction to Evidence-Based Medicine

In his 1971 publication ‘Effectiveness and Efficiency’, Archibald (Archie) Cochrane  strongly criticized the lack of reliable evidence behind many of the commonly accepted healthcare interventions at the time. His criticisms spurred rigorous evaluations of healthcare interventions and highlighted the need for evidence in medicine. His call for a collection of systematic reviews led to the creation of The Cochrane Collaboration. Archie Cochrane was a visionary person who helped lay down much of the foundation for evidence-based medicine (Ref 2009). 

Evidence based medicine (EBM), is a new paradigm for teaching and practice of clinical medicine introduced by the group led by David Sackett in 1992 (Ref 1992). EBM is an evolving discipline that has had a huge impact on the practice of medicine.

EBM requires the integration of the best research evidence, with the physicians clinical expertise and patients values expectations. (Ref 1995)  

‘Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming dictated by evidence. Even excellent external evidence may be inapplicable to or inappropriate for an individual patient. External clinical evidence can inform, but can never replace individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients’ (Ref 1995).

If you read one article to understand what EBM is, read this editorial published by Sackett in the BMJ – Evidence based medicine: what it is and what it isn’t at this link.

‘The phrase evidence-based medicine (EBM) was coined by Gordon Guyatt1 and then appeared in an article in The Rational Clinical Examination series in JAMA in 1992,2 but the roots of EBM go much further back. The personal stories of the origins of EBM were recently explored in a filmed oral history of some of the individuals most strongly associated with the birth of the movement (see Video, Evidence-Based Medicine: An Oral History).

Just 20 years after the term EBM began to be used, an early and informal history has emerged. JAMA and the BMJ invited 6 individuals who have played a prominent part in the development of EBM to participate in an oral history event and filming. Videos of this event and of interviews with 3 other EBM leaders (Box) have been woven together and may be accessed at

For the past decade EBM has gone through some difficult times as it was used by many with vested interests for purposes other than what it was proposed for, to increase the quality of care.  In 2014 Greenhalgh [Ref] identified negative unintended causes for the EBM crisis and suggests a process to bring it back on track. In 2016 Ioannidis [Ref] in a report to Sackett reiterates that  EBM has been hijacked its important goal to be attained for the delivery of health care, but states EBM is still an unmet goal.

Ten essential papers for the practice of evidence-based medicine by David Nuan