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 (1) and integrating individual clinical expertise and the best external clinical evidence from systemic reviews (2). The philosophical origins extend back to the mid-19th century Paris (3).

Evidence-based medicine is said to be the beginning of a new paradigm in medical practice. It de-emphasizes intuition, unsystematic clinical experience, and pathophysiological rationale as sufficient ground for clinical decision making, and stresses on the examination of evidence from clinical research (4-6). Thomas Kuhn described scientific paradigm as ways of looking at the world define both the problems that can legitimately be addressed and the range admissible evidence that may bear on their solution (7). When defect in an existing paradigm accumulate to the extent that the paradigm is no longer tenable, the paradigm is challenged and replaced by a new way of looking at the world.

The foundation of the paradigm shift lie in development in clinical research over the last 50 years, especially with the development of randomized control trial (RCT) (4). RCT has now become the “gold standard” by which the choice of treatment and evidence to support its use is now judged (5). It is now being used in the approval of new drugs for clinical practice, in surgical therapies (8) and in diagnostic tests (9).

Systematic review using meta-analysis is gaining increasing acceptance as a method of summarizing the results of a number of randomized trials and ultimately may have as profound an effect on setting treatment policy as have randomized clinical trials themselves (10). EBM has contributed to our understanding of the meaning of the benefit and harm of treatment as reported in the literature, and it is often promoted as an aid to clinical decision making (11)

EBM has become more relevant in the current medical practise, as the previous methods of; “unsystematic clinical experience, and pathophysiological rationale as sufficient ground for clinical decision making” have become obsolete. The time where the legal fraternity tested a medical practitioner professional negligence base on the Bolam test (1957); “A doctor is not negligent if he has acted in accordance with a practice accepted as proper by responsible body of medical men skilled in that particular art, merely because there is a body of opinion that takes a contrary view” has passed after the Rogers vs Whitaker case in 1992; where it stressed on evidence and personal self determination. With this the medical practitioners should be more incline to base the management of patients on the best available medical evidence.

The workshop on EBM will be conducted by experts from the Centre for Evidence-Based Medicine (CEBM) at Oxford University, the United Kingdom. CEBM is one of the partners in the European Asia-Link Programme; “Asia Europe Clinical Epidemiology and Evidence-Based Medicine Programme”. Further information about the workshop/course will be made available from this web site and at www.asialink-ce.org.

  1. Sackett DL, Richardson WS, Rosenberg W, et al. Evidence-based medicine: how to practise [sic] & teach EBM. Edinburgh: Churchill Livingstone, 1998.
  2. Sackett DL, Rosenberg WMC, Gray JAM, et al. Evidence-based medicine: what it is and what it isn’t. BMJ 1996; 312: 71-72.
  3. The NHS R&D Centre for Evidence-based Medicine in Oxford, Status Report, 1998 (Internet communication, 24 Dec 2000 at http://cebm.jr2.ac.uk/pub /documents/annrep98.rtf).
  4. Guyatt G, Cairns J, Churchill D, et al. Evidence-based medicine: A New Approach to Teaching the Practise of Medicine. JAMA 1992; 268: 2420-25.
  5. Eden T. Evidence-based medicine. Arch Dis Child 2000; 82: 275-77.
  6. Kew ST. Clinical Practise Guideline and Evidence-based Medicine. 7th National Healthcare Conference and Exhibition; Kuala Lumpur1999.
  7. Kuhn TS. The structure of Scientific Revolutions. Chicago: University of Chicago Press; 1970.
  8. European Carotid Surgery Trialists’ Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet 1991; 337: 1235-43.
  9. Larsen ML, Horder M, Mogensen EF, Effect of long-term monitoring of glycosylated hemoglobin levels in insulin-dependent diabetes mellitus. New England Journal of Medicine 1990; 323: 1021-25
  10. L’Abbe KA, Detsky AS, O’Rouke K. Meta-analysis in clinical research. Annals of Internal Medicine 1987; 107: 224-33.
  11. Djulbegovic B, Hozo I, Lyman GH. Linking Evidence-Based Medicine Therapeutic Summary Measures to Clinical Decision Analysis (Internet communication, 28 Dec 2000 at http://www.medscape.com/Medscape/ GeneralMedicine/journal/2000/v02.n01/mgm0113.djul/pnt-mgm0113.djul.html).