2001/04/01 by John M. Eisenberg
Health Professions · Economics, Econometrics and Finance · Pharmacology, Toxicology and Pharmaceutics · #Healthcare cost, quality, practices #Health Systems, Economic Evaluations, Quality of Life #Pharmaceutical industry and healthcare
paper · doi:10.1215/03616878-26-2-369
Popular attention has focused of late on the role of evidence in health care. Physicians have been encouraged to practice “evidence-based med-icine, ” so that their clinical decisions would be based upon a foundation of solid science, especially using research that has applied rigorous epi-demiologic methods and has been published in peer-reviewed journals. Evidence-based medicine involves increased reliance on formal, system-atic analysis and synthesis of the research literature to determine clinical effectiveness. It challenges consensus-based judgments and applies criti-cal assessment of the available research to decide if there is method-ologically sound evidence that the outcomes of a clinical option are favorable, and it identifies types of patients for whom the service is most effective. The response of some clinicians has been gratitude for the recognition, implicit in evidence-based medicine, that the everyday practice of clini-cal care can be an intellectually rigorous undertaking. Others have responded less gently, asking, in essence, “So what have I been practic-ing, magic?” Indeed, there is sufficient evidence to suggest that most clinicians’ practices do not reflect the principles of evidence-based medicine but rather are based upon tradition, their most recent experience, what they learned years ago in medical school, or what they have heard from their