Evidence Based Medicine

It’s widely believed that Evidence Based Medicine was first developed at the McMaster School of Medicine in 1965. This claim was made by four early entrants in the field, who published a book in 1985 called Clinical Epidemiology: A Basic Science for Clinical Medicine. In it they maintained that they’d pioneered a course in this subject in 1965 and were ‘the first medical school in the country to introduce problem based learning’. The world has accepted this claim, which the medical profession has rightly described as ‘a medical milestone’. According to Wikipedia, the online encyclopaedia: ‘The explicit methodologies used to determine ‘best evidence’ were largely established by the McMaster University research group led by David Sackett and Gordon Guyatt. (They didn’t use the term Evidence Based Medicine, which wasn’t coined until 1991 by David Eddy, in an article he wrote in the Journal of the American Medical Association.)

A more thorough investigation suggests that Evidence Based Medicine was first introduced at the British School of Osteopathy, London in the late 1950s when Donald Norfolk, a recent graduate from the school, was invited to lecture to the final year students. He offered to do so without any remuneration providing he was given the freedom to pick the subject he taught, the way it was presented and the material it contained. At the time osteopathic treatment was solidly based on traditional treatment procedures. The rationale was that what had been done by the profession’s revered founder Andrew Taylor Still should be accepted without question as the template for all subsequent osteopathic practice. (The same applied at the time in medical circles, where doctors were expected to treat their patients according to the principles laid down by Hippocrates, Galen, Avicenna and Sir William Osler) On the syllabus of the British School of Osteopathy, this subject was described as ‘Applied Anatomy and Physiology.’ Since it was

a totally new approach, the class worked as a team – students and recently qualified teacher – taking every condition commonly treated by osteopaths, and devising a rational treatment approach based strictly and solely on the latest anatomical and physiological research. That modest experiment preceded the work at the McMaster School of Medicine, and might well be judged the start of Evidence Based Medicine, were it not for the fact that Claude Bernard the nineteenth century French physician clearly got there first. He urged doctors to adopt the new scientific method rather than continue their slavish observance of the art and teachings of the old clinicians. ‘When we meet a fact which contradicts a prevailing theory’,

he asserted, ‘we must accept the fact and abandon the theory.’

© www.donaldnorfolk.co.uk

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