History of evidence‐based medicine. Oranges, chloride of lime and leeches: Barriers to teaching old dogs new tricks

Abstract

Knowledge translation is the process of taking evidence from research and applying it in clinical practice. In this article I will cite some pivotal moments in the history of medicine to highlight the difficulties and delays associated with getting evidence into practice. These historical examples have much in common with modern medical trials and quality improvement processes. I will also review the reasons why evidence is not used and consider what factors facilitate the uptake of evidence. Understanding these concepts will make it easier for individual clinicians and institutions to change clinical behaviour and provide a starting point for those looking at implementing 'new' practices, new therapies and clinical guidelines. Finally, I will offer a list of criteria that clinicians might choose to consider when deciding on whether or not to adopt a new practice, treatment or concept.

How to Practice Evidence-Based Medicine

“…Although this trial was small, Lind’s results suggested that citrus was superior over the other scurvy treatments, even those recommended by the Royal College of Physicians (sulfuric acid) and the Admiralty (vinegar). (9;10)Thus, this trial serves not only as an early account of randomization and a defined treatment period, but also as an example of a fair test that refuted expert opinion.…”

Hierarchy of evidence and appraisal of limitations (HEAL) grading system

“…Although modern notions of evidence-based medicine surfaced in the early 1970s, its origins may be traced back much further (Claridge & Fabian, 2005;Doherty, 2005). One of the earliest recorded examples of a randomized controlled trial (RCT) occurred in 1662 when Jan Baptista van Helmont proposed that 200 or 500 people with fever or pleuritis be divided by cast lots (i.e., a random process) into two groups.…”

Evidence Based Medicine: Key Aspects in Clinical Decision Making

“…Among the six treatment, it was found that citrus serves as the better option for the treatment of scurvy despite of the those recommended by the Royal College of Physicians and the Admiralty which were sulfuric acid and vinegar respectively. This was a example of a fair test that refuted the expert's opinion [6,7].…”