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December 3, 2008

Incorporating Patient Preferences in Evidence-Based Medicine—Reply

JAMA. 2008;300(21):2483-2484. doi:10.1001/jama.2008.731

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.