The author gives an account of his three and a half decades of work on the concept of evidence-based medicine and how it came to prominence.

The physician must consider the potential benefits of the new procedure and then determine, through discussion with the patient, what value the patient places on those specific benefits.

Teaching medical students to use evidence effectively means helping them learn to analyze the quality of evidence, apply evidence-based recommendations to their own patients, rely on other evidence experts, and appreciate the complexity of medical decision making.

Comparative effectiveness research (CER) may become an important factor in Medicare coverage decisions, and the new health care law may make it more easily available to the public to help in medical decision making.

Do patients and their physicians retain the moral authority to make decisions that depart from evidence-based recommendations?

The Oxford Centre for Evidence-Based Medicine provides a scale for stratifying evidence from strongest to weakest on the basis of susceptibility to bias and the quality of study design.

Physicians are not obligated to offer testing or treatments that are not medically indicated—even if patients demand them. This does not mean, however, that a physician should be dismissive of the patient’s concerns.

Guidelines require interpretation and should not be mindlessly applied as a template of care for all patients, particularly when there are inconsistencies between clinical practice guidelines developed by medical groups.

While practicing evidence-based medicine may maximize the likelihood of positive outcomes in a large population, it does not necessarily yield the best decision in a particular situation. To date, EBM proponents have not figured out how to account for patients’ differences from trial subjects, intangible factors detectable by experienced doctors, and patients’ values.

An overview of the negative health effects of smoking and the benefits to be gained from quitting.