Archie must be in there somewhere. Effectiveness and Efficiency (almost
certainly, knowing Archie, a sly reference to Health and Efficiency a small
magazine dedicated to udressed ladies) published in 1972 but Archie had been
preaching about evidence for many years before that. Perhaps Iain Chalmers can
tell us.
Norman

Dr Norman J Vetter
Department of Epidemiology
cardiff University
Heath Park Campus
Cardiff, CF14 4XN
UK

Tel: +44 (0)29 20 742311
       +44 (0)29 20 742318
Fax: +44 (0)29 20 742898

Web: www.normanvetter.com

>>> "Djulbegovic, Benjamin" <[log in to unmask]> 13/02/2005 04:27:15 >>>
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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