Whither evidence based medicine?

It's been 18 years now since evidence based medicine (EBM) became a catch phrase. Richard Smith, a former editor for BMJ, reflects on the distortions and unintended consequences of EBM as a “movement” in this month's The Scientist.


David Sackett and others once tried, in their classic BMJ editorial, to explain what EBM is and what it isn't. But, 18 years later, among academics, policy makers and practicing physicians alike it seems anything but clear what it is and what it isn't. There is a pure notion of EBM out there somewhere, perhaps best stated in the opening sentence of the Sackett editorial---“It's about integrating individual clinical expertise and the best external evidence.” But in real world application it's all over the place as Smith explains.


That's why it's folly to suppose that some central authority can dictate “what works and what doesn't work” for every patient and somehow homogenize the Dartmouth Atlas maps by bringing doctors into “compliance with EBM.”


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