Evidence-based medicine: what it is, what it isn't, and are we practicing it?

W hear a lot these days about the concept of ‘‘evidence-based medicine.’’ Six years ago, one of our most illustrious and intelligent presidents also made it the subject of a presidential address. I will cover a little of the same ground, but bear withme andwewill sail into some different seas, as I will address the use of nonYevidence-basedmedicine in some aspects ofmodern medical care, rather than the exciting possibilities that Fred Moore described. I think we all have an idea of what evidence-based medicine means to us personally, but in fact, there is a definition that is accepted by some major organizations devoted to the study and promotion of the concept, and there is a large body ofwork by these organizations and others around the topic. ‘‘Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.’’ This relatively recent definition implies that the concept is modern, but look at the key word current, and one can see that the concept can be said to be timeless, for what is current changes as our knowledge base changes. To me, one of the things that is interesting about this concept is how physicians have practiced evidence-based medicine through the years. To illustrate this, I would like to take you back to the time of the Napoleonic wars, at the turn of the 19th century, when the English Royal Navy battled for the control of the seas. Some of youmay be familiar with a series of novels by a wonderful author of historical fiction named Patrick O’Brian. Between 1970 and 1999, O’Brian produced the 20-book series, which aficionados call ‘‘TheAubrey-Maturin Series’’ (Fig. 2). Mark T. Metzdorff, MD, Western Trauma Association president. WTA 2013 PRESIDENTIAL ADDRESS