Evidence-based medicine: Why the time is now

politics, quality Abstract Four of the five factors necessary for an innovation to take hold – compatibility with existing values and behaviours, lack of complexity, the ability to be subjected to experiment (trialability), and the ability to produce results everyone can see (observability) – are now present in regard to evidence-based medicine. The fifth factor – relative advantage – is only partly present, but it is becoming more prevalent. Barriers include the failure of patients and doctors to differentiate between scientific training and scientific practice, to be seduced by technology and to be influenced more by pop-culture portraits of medicine than by the medical literature. Moreover, it has not yet clearly been demonstrated that it is to the economic or political advantage of any interest group to push for evidence-based medicine. Part of the reason is that there have been no easily identifiable victims to galvanise political pressure from the general public. Nonetheless, the situation is changing for the better. A CASE HISTORY The patient was a 67-year-old male with a persistent fever and sore throat. The sore throat responded readily to conventional therapy, but treatment for the fever left the patient progressively weaker and in great pain. Like many of the elderly, the patient remained grateful to his doctors and did not blame them for his failure to improve. On the contrary: as his condition worsened, he finally asked his doctors politely to ‘let me go off quietly’. And with those last words, George Washington died. When it comes to the deaths of US presidents, everyone knows that Abraham Lincoln and John F. Kennedy were killed by assassins ’ bullets. Few, however, realise that George Washington was killed – inadvertently, of course – by his doctors. Riding near his Mt Vernon home one winter day in 1799, he came down with a fever and sore throat. In trying to cure the former, his doctors bled him to death, using a therapy everyone ‘knew ’ worked, but which had only tradition to back i