What's the evidence for evidence-based medicine

Source: THEBMJ 2004

In a far-reaching essay, Trisha Greenhalgh reviews the accomplishments and remaining failings of Evidence-Based Medicine (EBM), a twenty-year-old movement that sought to reorient medical education and reinvigorate clinical practice. EBM arose to replace a perceived clinical overreliance on tradition and anecdotal evidence. It called for better evidence from randomized controlled trials and observational studies in order to make medicine a more empirical science. At first, EBM was successful, collecting information from well-controlled clinical trials, developing clinical guidelines from those data, and building probabilistic techniques into clinical practice. EBM, however, was gradually undermined. Vested interests (e.g., Big Pharma) found ways to manipulate and bias the evidence-gathering process itself; bureaucratic interests led to clinical guidelines that were management- rather than patient-driven; and EBM guidelines that were developed in response to single isolated medical issues often mapped poorly to complex real-world illnesses. Greenhalgh calls for a “renaissance” of EBM, mending its weaknesses and making the most of its strengths.