Dear All,
As several folk have pointed out, the history of EBM is long & complex.
The term "EBM" was suggested by Gordon Guyatt when the McMaster group were
developing the JAMA User Guide series in the early 1990's*.
But the ideas behind EBM, including clinical epidemiology and systematic
reviews, had been cooking for much longer time, and on several continents.
Two historical resources of interest are:
1. The James Lind Library traces many of the ideas about the generation and
organisation of good evidence ("fair tests of treatment"),
including the development of blinding, allocation concealment etc. See
www.jameslindlibrary.org for a wonderful historical resource going back
several centuries.
2. A book by Jeanne Daly tracing the history of EBM over the last 4 decades
will appear in May:
http://www.ucpress.edu/books/pages/9568.html
Best wishes,
Paul Glasziou
* We all tell the history from our own perspective. My own interest was
sparked by the 1st edition (1976) of Henrik Wulf'fs book Rational Diagnosis
& Treatment (translated from the Danish). But the most eye-opening
experience was going an ward rounds at McMaster in the late 1980's (before
the term EBM) and seeing research articles in the backs of patient's charts
and students carrying diagnostic nomograms in their pockets, which they
duly pulled out to calculate post-test probabilities from the patient's
ferritin level. This bedside EBM was being practiced well before the term
was coined.
At 14/02/2005, Norman J Vetter wrote:
>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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Paul Glasziou
Department of Primary Health Care &
Director, Centre for Evidence-Based Practice, Oxford
ph: 44-1865-227055 www.cebm.net
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