A Medicine Based on Evidence

Abstract

From its earliest beginnings, medicine—the discipline devoted to heal human beings—naturally began collecting evidence of good practice and of failures, and to learn from experience. These early databases of causal relationships and information about results developed, through the centuries, into a considerable repository of knowledge, tradition, and critique. In attempting to update this repository, contemporary medicine is facing an on-going dilemma in deciding what new is to be included and what old is to be removed. But the pool of accepted and questioned facts contained in the medical heritage is only one source of the difficulties now being encountered in identifying reliable evidence to be used in medical practice. Medicine per se is a combination of science (using strict methodologies), practice (utilizing accumulated and acquired expertise), and art (involving competence and skill), in its understanding and performance. All these components are necessary to practice medicine effectively. Thus, each one of them, although inherently incompatible, has to be reflected in the process of converting information into evidence, to generate guidance for preferred medical practice.