Epidemiology and evidence-based medicine (EBM) are, broadly speaking, about giving people the skills to evaluate and to produce evidence which can help to make clinical decisions. Many people can make use of those skills: EBM-enthusiasts, epidemiologists, physicians, surgeons, non-clinicians, patients, journalists and policymakers to name a few. However, the best way to teach those skills to the people who need them most is still elusive. Such skills are crucial if clinicians are to keep up-to-date in the rapidly evolving world of medicine.

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Gobsmacked, bamboozled, annoyed: my emotions on following news stories about the ongoing US healthcare reform debate this week. Then came the onslaught on the UK’s National Health Service by various Americans and Tory MEP, Daniel Hannan. Hannan described the NHS as “a 60 year mistake" and that he "wouldn't wish it on anyone".

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I first came across this story a few weeks ago when Obama was asked questions about health care reform by Jon La Pook at CBS news. Here is the crucial bit of the interview

Dr. La Pook: “ …... So they have on the one side their intuition as a physician, in their bellies, and then there's the evidence-based medicine that we talk about, and they clash a lot at times, so how do you make that doctor do the right thing or give him the right incentives?”

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Only last week, Paul Glasziou alerted me to an editorial by David Sackett on 'Evidence-Based Medicine what is and what it isn’t' [1] which had been cited as the second most accessed paper on the BMJ website. I guess this wouldn’t be of interest until you realise the article is 13 years old - published in 1996.

The major contribution of this paper is the classic definition of EBM:

‘Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients’.

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