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The 11th hour-time for EBM to return to first principles?
  1. Denise Campbell-Scherer
  1. Correspondence to Denise Campbell-Scherer, 205 College Plaza, Department of Family Medicine, University of Alberta, Edmonton, AB, T6G 2C8, Canada; dlcampbe{at}

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In accordance with our editor's challenge to write about the translation of evidence into policy and practice,1 I have been reflecting on why this is seemingly so hard to do.

First, let us remember how Sackett defined evidence-based medicine (EBM).2 “Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research …. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights and preferences in making clinical decisions about their care.”

The story of evidence-based medicine is one of incredible success. In the last 20 years, the field has exploded, and done a lot of good. Therapies in wide use have been found to be unhelpful or dangerous3; there is increased knowledge of the characteristics of a trustworthy clinical trial4; there have been exponential advances in our ability to access literature and we have created new ways to synthesise and summarise our knowledge.

With this success, where is the rationalist dream of seamless translation? EBM is now the dominant paradigm in academic medicine – and this is problematic for several reasons.

In an address to the North American Primary Care Research Group (NAPCRG) professor Trisha Greenhalgh explored the …

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