Importance of evidence-based medicine on research and practice

Anaesthesia and evidence-based medicine (EBM) are considered as two of the 15 most important medical milestones. The birth of anaesthesia on 16 th October 1846 and the subsequent publication of this discovery as a case study 33 days later in the high-impact Boston Medical and Surgical Journal (the current New England Journal of Medicine) resulted in its widespread use that dramatically changed surgical practice. [2] Likewise, EBM, born at McMaster University in the early 90s, has had a considerable impact on the modern day health-care practice. 5 years later, the most-cited EBM landmark article described EBM as the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients. Another characterisation, appearing a few years later, described EBM as a systematic approach to clinical problem-solving that allows integration of the best available research evidence with clinical expertise and patient values. A final characterisation highlights three key principles underlying optimal clinical practice: systematic summaries of the best evidence, a schema for deciding what constitutes the best evidence and the prominent consideration of individual patient values and preferences. To understand the importance of EBM, one can begin with an appreciation of how medicine was practiced before EBM. Period before evidence‑based medicine Before EBM thinking began to impact on its structure, clinical practice relied on expert advice – often driven by physiological reasoning and individual clinicians' experience. This emphasis resulted in a significant gap between the available evidence and the actual clinical practice. Two examples will demonstrate why this was a problem. In 1992, Antman et al. published findings of their study comparing recommendations by experts with results of meta-analyses of randomised controlled trials (RCTs) (the best available evidence at the time recommendations were made) for treating myocardial infarction (MI). [7] For thrombolytic therapy for MI, after publication of 30 trials with >6000 patients, a 25% reduction in odds of death was observed. Despite this, additional trials recruiting another 40,000 patients, half of whom did not receive the proven benefits of thrombolytic therapy, were conducted. Disagreement between the experts providing recommendations of this therapy for the treatment of MI necessitated producing essentially redundant evidence, long after the answer was in. Only a decade after benefits were securely established, when evidence became completely overwhelming, did experts finally achieve a consensus regarding the use of thrombolytic therapy in ST-elevation MI. In another example, despite accumulating RCT evidence …