For my students in 2018, it’s difficult to imagine an era when there was no such thing as evidence-based medicine (EBM). When I started medical school in 1997, though, the term had only been in use for six years, having been introduced by Dr. Gordon Guyatt at McMaster University (though EBM’s intellectual origins can be traced to several key individuals). When I tell trainees how recently EBM began, they often ask, “Well, then, what kind of medicine did physicians practice before?” The answer is, we largely practiced “eminence-based” medicine (but this tongue-in-cheek article offered some equally poor alternatives).
Although it may be well established, the primacy of EBM is more fragile than it seems. In the September 15 issue of American Family Physician, my longtime mentor and editor emeritus Jay Siwek, MD reviewed common misconceptions, barriers, and practical solutions. For example, evidence can be distorted by financial conflicts, misinterpreted though the lens of one’s preexisting beliefs, or ignored by those who deride evidence-based practice guidelines (incorrectly) as “cookbook,” “one-size-fits-all” medicine. A recent essay in BMJ also described threats to evidence-informed policymaking driven by ideological decisions on both ends of the political spectrum:
We tend to alight on examples of harmful interventions that fit our own political preferences. For example, … public health researchers leaning towards the left might cite evidence that abstinence-only sex education is more likely to lead to increased sexual risk behavior than comprehensive sex education. … But only referring to examples where the evidence aligns with our own preferences risks suggesting to those on the left that they do not need evidence to know what does not work (as it is just obvious), and to those on the right that evidence-informed policy is a liberal conspiracy.
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