In search of the facts: Evidence-based medicine through the ages

Evidence-based medicine (EBM), defined as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients," is often seen as a 20th-century revelation. In fact, its roots extend deeply into the history of the healing arts. Modern attempts at making clinical decisions are increasingly based on scientific peerreviewed literature supported by the tenets of EBM. However, physicians throughout history have had to decide how to treat patients with their clinical decisions guided by the "evidence" of the time, which in many cases was limited by dominant theories of pathophysiology. In later eras, the advent of statistics and organized data collection allowed for the modern shape of EBM to evolve. We illustrate how EBM has reflected the changing scientific paradigms on which medicine is founded and urge practitioners and researchers to consider which paradigms may limit their own interpretations and concepts of evidence.