The rise and fall of EBM.

Abstract

The rise of Evidence-based Medicine (EBM) has been were never properly addressed—nonetheless CE was widely regarded as a refreshing approach that blew one of the more remarkable phenomena of the British health scene during the 1990s. Tremendous away cobwebs and let in some light. In particular, CE mobilized the enthusiasm of people to come to grips advances have been made in establishing the EBM brand name, obtaining massive government funding, with interpreting clinical data for themselves for use in their own clinical practice. manoeuvring to a position of unchallenged authority within the NHS managerial and political hierarchy But the advocates of clinical epidemiology were ambitious of influence, and grew impatient. A signi(and its priesthood among the BMJ editorial staff )— and promoting EBM as a marketing slogan for ficant change came when the name ‘Evidence-based Medicine’ or EBM was coined in 1992.2 Although lucrative conferences, courses, books, journals, people and organizations. the term involves a calculatedly dishonest misrepresentation,3 this new nomenclature was an immediate The ‘fall’ of EBM is rather different; since it involves a quasi-theological ‘fall from grace’: a loss rhetorical success. EBM effectively labelled itself as rational, objective and altruistic—while any opposiof clinical, scientific and educational integrity, even to the point of a decline into a ‘state of sin’ (if tion was implied to be promoting a practice that is illogical, self-indulgent and opposed to the evidence. seeking and clinging to power at any costs is seen as sinful). This moral decline would—in the normal A set of mission-statements was proposed as definitive of EBM: these took the form of platitudes which course of events—be followed in due course by loss of status, income and power. However, the EBM could not be opposed by any rational person;4 yet these content-free proclamations served to camoubarnacle may prove difficult to dislodge now it has a grip on the minds of politicians and managers. flage controversial ways of operating and marginalize opponents as wicked or crazy. Certainly, the phenomenon is ripe for re-evaluation.