Whose evidence do we follow?

Evidence-based medicine (EBM) is the cornerstone of current medical practice and education.[1] From its beginnings in the early 20th century, modern medicine grew on the basis of knowledge passed on by eminent practitioners, at times based purely on anecdotes and logic. But then, who would need a randomized trial to know that parachutes save lives? Some of the discoveries were so radical that to question them, or their innovators, would be blasphemous. The use of anesthesia, antisepsis, antibiotics, radical surgery for cancer, and chemotherapy delivered results that were so obviously superior to previous practice that they were rapidly adopted and disseminated. Over the last 30 years, the impact of new discoveries became progressively smaller. A new drug would provide improvement in 10% of patients and improve survival by 3 months, and a surgical technique would decrease hospital stay by 12 h. Along with smaller benefits came the growth of commerce and enterprise where each new discovery promised billions of dollars to its owners if it succeeded. Conflicting reports on outcomes with high‐profile endorsements created an environment of uncertainty where EBM provided a solution.