indeed, it would be good if some of the folks who were at forefront of the EBM movement join the debate and provide some further historical account how EBM field has evolved. In the article, Eddy states that he is the first to use the term "evidence-based (guidelines)" (1990), and that term EBM was first used by Gordon Guyatt in 1991. My own account of history of EBM has revolved around 3 development:
1. practice guidelines and need to standardize practice (USA)
2. critical appraisal (Canada)
3. systematic reviews (UK-Cochrane Collaboration)
For time being, these developments have been more or less independent and only recently we have seen attempts to integrate them under single EBM umbrella. The process is far from being finished, and to the large extent because all of the developments mentioned above tackle only superficially the activity which ultimately matters: decision-making under uncertainty. For some reason, we have been very slow in adoption of the methods for integration of evidence in decision-making (e.g. decision analysis etc).
I would be interested in hearing yours and others' thought on these developments which goal ultimately has been to introduce scientific rigour in the practice of medicine.
ben
-----Original Message-----
From: Evidence based health (EBH) on behalf of Poses, Roy
Sent: Sat 2/12/2005 6:31 PM
To: [log in to unmask]
Subject: Re: Innacurate EBM-labeled prediction dangers - Sackett said
I do not intend to mean any disrespect, and have no doubt that Eddy was talking and writing about these issues.
I am also answering this off the top of my head from home, and don't have any source material handy, and doing medical history off the top of one's head is hazardous, but,...
It seemed to me there were an awful lot of people also talking about these issues, and some earlier than the 1980's.
First of all, although the term evidence-based medicine (or health care) comes from the early 1990's, EBM or EBHC seems to me to be clearly a successor of the clinical epidemiology movement, which I believe dates from the 1970's, or earlier, and was put together by people from such places as McMaster, Oxford, University of Pennsylvania, University of North Carolina, and others. There was also sort of an alternative clinical epidemiology movement championed by Feinstein from Yale. I was taught clinical epidemiology at Penn, with emphasis on how to review articles that describe clinical research and apply the results to patient care, as a fellow starting in 1981. I was hoping some veterans of these times were on this mailing list and could enlighten us further. But lot's of people were talking about the quality of evidence by 1981 (and when I get to my office, I'm sure I can find some articles from that time to document this.)
Furthermore, having gone to my first Society for Medical Decision Making meeting also in 1981, I can also recall that lots of people were talking about uncertainty, balancing benefits and harms, and patients' values at that point, and that this movement also I believe started in the 1970s, if not before. I can recall that David Eddy had some role in this arena, but he had lots of company.
I have no problem with Eddy citing his own work. We all do that. But in a keynote article on EBM in a journal that does not feature a lot of EBM, I was hoping for a bit more balance.
Roy M. Poses MD
Center for Primary Care and Prevention
111 Brewster St.
Pawtucket
RI 02860
401 729-3400
fax 401 729-2494
email: [log in to unmask]
From: Djulbegovic, Benjamin
Sent: Sat 2/12/2005 4:16 PM
To: Roy Poses; [log in to unmask]
Subject: RE: Re: Innacurate EBM-labeled prediction dangers - Sackett said
Roy, perhaps Eddy is a bit exaggerating but he indeed was of one the first to talk about the quality of evidence, the role of uncertainty, need for balance sheets (already in 1980s)- well before the term evidence-based medicine was coined (1992, I think). Although he may be overinterpreting Wennberg's data, I tend to think that he is basically right- if medicine is science why there is so much variation in practice between different countries, hospitals or physicians (as opposed to, say, physics)? This question holds even when co-morbidities, patient preferences etc are taken into account.
ben
Benjamin Djulbegovic, MD,PhD
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