Journal of Orthopaedic Association of South Indian States

: 2021  |  Volume : 18  |  Issue : 2  |  Page : 43-

Evidence-based medicine

Suresh S Pillai 
 Editor-in-Chief, JOASIS; Senior Consultant Spine Surgeon, Department of Spine Surgery, Baby Memorial Hospital, Calicut, Kerala, India

Correspondence Address:
Suresh S Pillai
Baby Memorial Hospital, Calicut, Kerala

How to cite this article:
Pillai SS. Evidence-based medicine.J Orthop Assoc South Indian States 2021;18:43-43

How to cite this URL:
Pillai SS. Evidence-based medicine. J Orthop Assoc South Indian States [serial online] 2021 [cited 2022 Jul 6 ];18:43-43
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Full Text


It has been almost three decades since Gordon Guyatt of McMaster University introduced the term “Evidence-based medicine” for “scientific” approach to medicine. Through natural teething problems, it has grown through its infancy, adolescence, and youth to its current matured state. This has introduced “critical appraisal” of medical science by going beyond mere reading through medical literature. In 1991, an Evidence-Based Medicine Working Group was formed and published an article in JAMA. Then, this group published a series called “User's Guides to the Medical Literature” in JAMA between 1993 and 2000. Since evidence is never sufficient, clinical decision-making always depends on a bargain between desirable and undesirable events. Summaries of best available evidence pave way to good clinical decision-making.

Evidence-Based Medicine involves mainly three principles[1]: Summary of evidence of current practice, trustworthiness of evidence collected, and clinical decision-making. Clinical decision-making is never based on evidence alone. Clinical decision-making must consider the risk, benefits, costs, and burdens associated with different treatment modalities.

Hence, systematic summaries of current evidence help us make rational clinical decisions. How do we make unbiased best evidence and how we recognize it? This depends on the hierarchy of evidence. Clinical trials (therapeutic interventions) sit atop the evidence hierarchy, followed by multiple patient randomized controlled trials, observational studies, basic research involving laboratory, animal and human physiology, and clinical experience in that order. One of the main goals of Evidence-Based Medicine is optimal clinical decision-making consistent with patient values and preferences. However, it is of utmost importance to arrive at the correct diagnosis before going on search for the best evidence. The clinician should apply their expertise on the probable treatment result of each patient and the risks and benefits of that treatment to the particular patient. Evidence-Based Medicine can help patients achieve maximum health benefits from limited resources.