Evidence-based medicine (EBM) has been defined as the "conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."¹ It has been championed by many groups, particularly in Canada and England, as one way to address issues related to quality of care.^2-9 More specifically, EBM reflects a concerted effort to systematically retrieve and synthesize data, make the data available to physicians, and incorporate it into practice.¹⁰ Intuition and individual clinical experience are deemphasized and decision-making based on evidence is stressed. Although there have been some concerns about whether there is sufficient evidence to guide many of our clinical decisions, about what represents the best available evidence, and about the authoritarian voices of the EBM movement, it should be our goal to make the most informed medical decisions on behalf of patients.^11-13

Why is EBM important? Is it just another epidemiologic fad, one that will gradually fade into the sunset? EBM originates from the ongoing concerns about quality of care, including individual, institutional, and regional variations in diagnostic testing, hospitalization rates, therapeutic interventions, and outcomes.^14,15 For example, in pediatrics, there are ample data indicating that the care of many children with asthma is not consistent with the guidelines from the American Academy of Pediatrics (AAP) or the National Institutes of Health.^15,16 In some regards, EBM represents the culmination of such methodologic approaches as decision analysis,¹⁷ meta-analysis,^18-19 practice guidelines,²⁰ clinical pathways,²¹ disease management,^22-23 systematic reviews (Cochrane Collaboration),^24-27 and critically appraised topics.²⁸ In fact, EBM relies on all these methods, and they represent the traditional science of EBM.

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