Evidence Based Medicine: Past, Present, Future

Early medical traditions include those of ancient Babylonia, China, Egypt and India. The roots of modern western medicine, however, go back to ancient Greece. During the Renaissance, physicians increasingly relied on observation and experimentation to understand the human body and develop new techniques for diagnosis and treatment. The discovery of antibiotics, antiseptics, and other drugs in the 19th century accelerated the development of modern medicine; the latter being fueled further by advances in technology, research, a better understanding of the human body, and most recently by the introduction of Evidence-Based Medicine (EBM) The EBM model de-emphasized intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and stressed the examination of evidence from clinical research. A later EBM model additionally incorporated clinical expertise and the latest model of EBM patient’s preferences and actions. In this review article we argue that in the era of precision medicine, major EBM principles must be based on a) the systematic identification, analysis and utility of big data using artificial intelligence, b) the magnifying effect of medical interventions by means of the physician-patient interaction; the latter being guided by the physician’s expertise, intuition, and philosophical beliefs, and c) the patient preferences since, in health care under precision medicine, the patient will be a central stakeholder contributing data and actively participating in shared decision-making.