SPINE Volume 36, Number 17, pp E1121–E1125
©2011, Lippincott Williams & Wilkins
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
The Pros and Cons of Evidence-Based Medicine
MD * Antti Malmivaara
MD † and
Maurits van Tulder
n a debate “Evidence Based Medicine: Saviour or Pariah”
9th International Forum on Low Back Pain Re-
search in Primary Care
, evidence-based medicine (EBM)
made it as savior but it was close. Championed by Sackett
in the 1990s,
EBM has received both support and criticism
from researchers, clinicians, and policy makers. In this paper,
we consider some common arguments for and against EBM.
WHAT EXACTLY IS EBM?
“Evidence-based medicine” conveys the idea that up-to-date
evidence can be used and applied consistently in clinical prac-
tice, in combination with the clinician’s individual expertise
and the patient’s own preferences and expectations, to achieve
the best possible outcomes. Evidence is provided by original
research and by systematic reviews that F nd, select, judge, and
integrate the evidence on any topic. This provides the basis for
treatment guidelines, which incorporate expert interpretation
of available evidence, at the same time taking additional argu-
ments into account, such as treatment availability, costs, and
Hence, we move from evidence to practice.
Experience- or Evidence-Based Medicine?
Clinical proponents of EBM have emphasized the range of evi-
dence that can be used in clinical decision-making.
dence” can apply to any observation, so proponents could ar-
gue that there is always evidence, even if it is clinical experience
without research data.
The acronym may in reality mean “ex-
perience-based medicine.” Much of the evidence in any clinical
guideline is likely to come from expert opinion. Most guideline
* Arthritis Research UK National Primary Care Centre, Keele
University, Keele, Staffordshire, United Kingdom ;
† Centre for Health and
Social Economics, National Institute for Health and Welfare, Helsinki,
‡ Department of Health Sciences and the EMGO Institute for Health
and Care Research, VU University, Amsterdam, The Netherlands
Acknowledgement date: July 19, 2010. Revision date: September 22, 2010.
Acceptance date: October 1, 2010.
The manuscript submitted does not contain information about medical
No funds were received in support of this work.
ts in any form have
been or will be received from a commercial party related directly or indirectly
to the subject of this manuscript.
Address correspondence and reprint requests to Maurits van Tulder, PhD,
Department of Health Sciences, EMGO+ Institute for Health and Care
Research VU University, De Boelelaan 1085, Room U454, 1081 HV
Amsterdam; E-mail: firstname.lastname@example.org.