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In Reply: The history of EBM and its intellectual forebear, clinical epidemiology, starts long before 1993 when the first Users' Guides publication appeared. Daly's book describing the development of EBM¹ suggests that the primary motivations among the early pioneers of this movement (eg, Alvan Feinstein, David Sackett) were to bring the scientific method to the practice of medicine, to distinguish between effective and ineffective care (Archie Cochrane), and to overturn the earlier paradigm of clinical practice based on authority and dogma (Sackett). The humanistic and ethical aspects of medical practice were emphasized by Henrik Wulff² and Gordon Guyatt, but the main impetus and primary focus of the movement has historically been, and arguably currently remains, on bringing rational, quantitative methods to the practice of medicine.

We acknowledge that since the early 1990s leaders in the EBM movement have emphasized the importance of patients' preferences and more recently have discussed the . . . [Full Text of this Article]

Murray Krahn, MD, MSc
murray.krahn@theta.utoronto.ca
Toronto Health Economics and Technology Assessment Collaborative

Gary Naglie, MD
Department of Medicine
University of Toronto
Toronto, Ontario, Canada

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