OK. So I was lucky enough to be part of the 'Sackett generation' at Oxford University Medical School 1992-1995. An inspirational teacher who offered significant first hand experience in this field.

Before EBM: Experience-based medicine. A lot of 'grandfather/grandmother' medicine ie we do it because our forbears advise it.

The major flaw with EBM in the early years related to uptake. The truth was that the best and brightest had already worked out how best to treat their patients and still had pretty good outcomes. It was those physicians/surgeons who were weaker clinically that had most to gain from EBM and so embraced it first. This led to a dichotomy: with the most respected and able doctors only rarely using EBM and the least able using it as a tool to justify their (sometimes ropey) decision-making.

Sackett idenitified (to us) that it was not to be used as a tool for denying patient care, or indeed criticising colleagues - but invariably it has been used like this and continues to be. This has led to what I call 'Evidence based fascism' - where appropriate treatments are denied to patients on the altar of 'no evidence'.

Children, in particular are poorly served by the EBM debate. Here, there are countless examples now in the UK of care/treatment being denied to children because evidence is lacking. Usually this is because studies have not been done - and often are either very difficult or impossible to get funded.

Still EBM overall has been a force for improvement - in general reducing the variation in outcomes and I would use 'variation in outcome' as your primary end point for any study.

In so-called primitive societies of all times, medicine was based on magic, that is, the human power to sway supernatural forces. The original doctor was the shaman, or witch doctor.  Ancient Semitic medicine holds that sickness is based on sin; wrongdoing produces illness as punishment of the gods or of God.  Ancient Greek and Roman medicine based medicine on nature. Empedocles divided nature into four elements, earth, air, fire, and water, which governed the four humors in man.  Christian medicine reconciled the two outlooks- the Semitic and the Greek-Roman-- in the notion of sickness as a trial sent by God, with the physician helping in spiritual as well as physical cleansing. The theory of the four humors governed medicine until well into the Baroque. In actuality, ebm does not come into its own until the 19th century, so it comes at the end of a long evolution. Today we take ebm for granted, but throughout the history of medicine other medical bases predominated. I rely for my information on the books of my teacher of history of medicine Pedro Laín Entralgo, especially, "La enfermedad y el pecado" [Sickness and Sin].

OK. So I was lucky enough to be part of the 'Sackett generation' at Oxford University Medical School 1992-1995. An inspirational teacher who offered significant first hand experience in this field.

Before EBM: Experience-based medicine. A lot of 'grandfather/grandmother' medicine ie we do it because our forbears advise it.

The major flaw with EBM in the early years related to uptake. The truth was that the best and brightest had already worked out how best to treat their patients and still had pretty good outcomes. It was those physicians/surgeons who were weaker clinically that had most to gain from EBM and so embraced it first. This led to a dichotomy: with the most respected and able doctors only rarely using EBM and the least able using it as a tool to justify their (sometimes ropey) decision-making.

Sackett idenitified (to us) that it was not to be used as a tool for denying patient care, or indeed criticising colleagues - but invariably it has been used like this and continues to be. This has led to what I call 'Evidence based fascism' - where appropriate treatments are denied to patients on the altar of 'no evidence'.

Children, in particular are poorly served by the EBM debate. Here, there are countless examples now in the UK of care/treatment being denied to children because evidence is lacking. Usually this is because studies have not been done - and often are either very difficult or impossible to get funded.

Still EBM overall has been a force for improvement - in general reducing the variation in outcomes and I would use 'variation in outcome' as your primary end point for any study.

Please, specify the time period after which starts EBM, in your study or generally, to know to what defined historical period your question is related.

Hello Mr. Malobabic, 

I start to define EBM with the definition by Dave Sackett, i.e. in the 1970's. As a concept, EBM, or a very rough form of it existed before that, but I am concerned with the the overall definition in the 18th, 19th, and 20th century definition of medicine. Everything before that starts to go beyond the scope of my work, even though it is really interesting. 

Thanks for all the good answers. 

Caroline

Medicine before EBM depended on exchange of experience regarding applying efficient therapeutic methods & exclusion of non-efficient ones i.e. observation based medicine until reaching comparative study & finally EBM with emission of different clinical guidelines. So Medicine before EBM may be considered the basic of recent EBM.