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The Forerunners of EBM

The term “evidence-based medicine” first appeared in the medical literature in 1992. It quickly became popular and developed into a systematic enterprise. A book by Ulrich Tröhler To Improve the Evidence of Medicine: The 18th century British origins of a critical approach argues that its roots go back to the 1700s in Scotland and England. An e-mail correspondent recommended it to me. Can’t remember who, but I would like to thank him.

Francis Bacon (1561-1626) differentiated between “ordinary experience” (chance observations) and more objective “ordered experience” (methodological observations). Both of these involved empirical knowledge.  It’s hard to get back into the mindset of his time, when most physicians rejected empiricism as the sphere of quacks and surgeons.  Tröhler helps us understand why they did:

…since antiquity, the mark of distinction of a learned man had been the certainty of his knowledge. A doctor knew — he did not need to test his kind of knowledge empirically because this would imply acknowledgement of uncertainty.

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