As medicine and magic began to slowly part ways in the Enlightment era, scientific evidence became the driving force and currency of medicine. As scientific evidence was being defined, the newly established medical schools imparted this knowledge to their students. Those who mastered the evidence, and committed to adhere to it, became physicians who enjoyed public trust and the statutory position that came with it. With some exceptions, the idea that scientific evidence should constitute the only foundation for medical practice has withstood the test of time and the occasional attacks, by well-meaning but naïve individuals as well as charismatic charlatans.

The principal stakeholders of clinical practice - consumers, practitioners, and providers of services and products - are all trying to influence the stream of evidence. The current debate on EBM focuses on what constitutes true scientific evidence, and how best to translate this evidence into clinical practice. The evidence available to the practitioner varies widely in terms of source, quality, and potential for bias, while the relevance of evidence, derived from statistical analyses of data from mega-trials, to the treatment of individual patients is sometimes difficult to grasp.

This presentation will discuss the gap between EBM and clinical practice and ways to bridge the two.