For much of modern medicine, clinical decisions leaned on tradition, authority, and experience. Physicians often followed longstanding practices because “that’s how it’s always been done.” But in recent decades, a quiet revolution changed everything: the rise of evidence-based medicine (EBM). EBM has reshaped clinical care. Now, it’s time for that same rigor to permeate public health and policy.
EBM empowered clinicians to ask: What does the evidence actually show? Instead of relying on anecdote, intuition or influence, providers began integrating the best available research with professional judgment and patient values.
This transformation didn’t just alter bedside care—it redefined how we think about knowledge, quality, and accountability in medicine. And now, it’s time to embrace that transformation beyond clinical walls.
How Evidence-Based Medicine Changed the Game
Evidence-based medicine challenged the status quo. It is driven by data and emphasizes transparency over tradition. Central to EBM is the integration of three elements:
- High-quality, critically appraised research
- Clinical expertise
- Patient priorities and values
Health services researchers helped lead this movement. They developed frameworks and better methods for evaluating clinical interventions, built tools for decision-making, and worked to reduce variation in care.
Today, systematic reviews, randomized trials, and meta-analyses guide everything from clinical guidelines to reimbursement decisions. But that infrastructure didn’t emerge organically. It came from decades of effort—fueled by people willing to question assumptions and demand stronger evidence.
Cochrane and the Power of Systematic Reviews
In 1993, the Cochrane Collaboration took that demand to a global level. Named for epidemiologist Archie Cochrane, the organization began producing rigorous, transparent, and regularly updated systematic reviews of healthcare interventions.
Cochrane’s work helped standardize evidence synthesis. It didn’t just answer individual questions—it created infrastructure for thinking critically at scale. Clinicians, researchers, and policymakers around the world began using Cochrane reviews to inform everything from clinical decisions to national guidelines.
But Cochrane isn’t alone. Initiatives like the U.S. Preventive Services Task Force, AHRQ’s Evidence-based Practice Centers, and the GRADE working group have all expanded the reach and relevance of EBM.
The Limits of Evidence-Based Medicine—and Need for Broader Adoption
Despite its success in clinical practice, EBM often stops short of shaping broader public health or policy decisions. Too many programs still launch based on hunches, cultural or political trends, or the appeal of novelty—rather than sound evidence.
In my own work across varied political and institutional settings, I’ve been struck by how sweeping decisions often proceed with minimal evidence; or worse, how a single flawed study can upend an entire program. This isn’t just inefficient—it’s dangerous. It erodes trust, wastes resources, and delays interventions that actually work.
Public health doesn’t lack intelligence or passion. And much public health work–including the effectiveness of immunization and anti-smoking campaigns–has a strong evidence base. At times we lack insistence—on rigor, on evidence, and on transparency. We may even be afraid to challenge evidence presented as fact or to admit we are wrong. And we need to insist on better translation of evidence into practice.
A Call to Action: Evidence Beyond the Clinic
As public health practitioners and researchers, we must carry the EBM torch forward. That means:
- Embracing evidence-based practices in program design and evaluation
- Contributing to the identification and validation of those practices through research, data analysis, and vigorous, even messy, debate
- Demanding that public policy be guided by credible, transparent evidence, not ideology or anecdote
We already have the tools. What we need is the resolve to use them—and the courage to ask harder questions of ourselves and our systems. This vision aligns with the principles of a learning health care system, where every action contributes to better evidence, and every decision is part of a continuous cycle of improvement.
Furthering an Evidence Culture
The rise of EBM continues to reshape clinical care. Now, it’s time for that same rigor to permeate public health and policy. Let’s not allow a discipline dedicated to population well-being to operate on anything less than the best knowledge available.
The next chapter of evidence-based practice isn’t about guidelines—it’s about governance. It’s about building a culture where every decision is accountable to the data, and every intervention earns its place through results, not rhetoric.
The EBM revolution started in hospitals and clinics. But its future in public health—and its impact—depends on us.
Cole Ettingoff