Medicine was the first to introduce an evidence‐based approach to clinical practice in the 18th century when navigation was important for overseas trading in the United Kingdom. Long journeys to Australia and the Far East were taking place with sailors deprived of fresh fruit and vegetables, which resulted in scurvy and other medical problems. James Lind MD, the surgeon to the British Navy, wrote an article on Treatise of the Scurvy, which g ignored for many years. Still, it is considered the first controlled clinical trial to translate into clinical practice by stocking long‐distance trade ships with lemons and limes to avoid the ship’s crew members from developing scurvy1.
In 1971, the British epidemiologist, Archie Cochrane, in his influential monograph titled “Effectiveness and Efficiency,” introduced a new concept which tells that all treatment interventions must be proven to be effective before introducing it into clinical medicine. The above idea supported by an early example in which data were combined from multiple clinical trials investigating premature births and infant mortality.
By 1974, all controlled trials in perinatal medicine had systematically identified and entered into a clinical trial register.
By 1987, the year before Archie Cochrane died, 600 systematic reviews on health‐care topics had been published.
Archie Cochrane, a person whose ideas initially rejected in the medical community, had a significant impact on the medical field. His strong faith in finding evidence for therapeutic interventions’ effectiveness resulted in the development of randomized clinical trials (RCTs) and SRs of the scientific literature. It established a new era in medicine, the one that would ultimately influence dentistry.
The Cochrane legacy
The Cochrane Collaboration was established a year after Archie Cochrane’s death. In the 21st century, Cochrane Collaboration recognized as an international organization that prepares maintains and promotes accessible SRs on the effectiveness of health‐care interventions from which well-informed decisions emerge25.
The familiar logo of the Cochrane Collaboration represents and acknowledges the impact of Archie Cochrane’s life. The outer blue semicircles depict the Cochrane Collaboration and the inner circle, the globe, to describe international collaborations. Inside the rings, encircles the forest plot, which represents the results of a quantitative meta‐analysis. This forest plot represents one of the earliest SRs and M-As of the literature on the therapeutic intervention of corticosteroids in women who were to deliver their babies prematurely. The diamond to the left of the “no effect” line indicates the M-As favored the intervention.
The Cochrane Collaboration
The Cochrane Collaboration has influenced and driven the science and methodology of systematic reviews. It has compared to the revolutionary Human Genome Project in its potential implications for contemporary health care.
To date, medical and dental regimens have remained unchanged even when well‐designed clinical trials have proven superior to the prior regimens. Treatment decisions based on clinical experience and beliefs are difficult to change. It takes an average of 17 years for a finding from clinical trials to be implemented into clinical practice.
Even though we are in the 21st century, when evidence is convincing, clinicians may still find it challenging to give up their beliefs based on their clinical experiences.
The Influence of David Sackett
Clinicians and academicians interested in evidence‐based medicine consider Cochrane, Feinstein, and Sackett the “fathers” of evidence‐based medicine29.
Dentistry has adopted an evidence‐based approach and has benefited from medicine in teaching and practicing an evidence‐based approach, and conducting systematic reviews and meta-analysis of treatment interventions with well‐defined, reliable, and valid outcomes1.
David Sackett and clinical epidemiology had a vast influence among the orthodontic attendees when Bob Moyers had invited David Sackett to participate in the Moyers Symposium on three occasions over 30 years, starting in 1985.
In the 1985 symposium, Sackett criticized orthodontics for lagging in conducting orthodontic trails. There were no RCTs in orthodontics before 1967. It was only a rate of one trial every two years during the next decade. In 1994, when Sackett attended the Moyers Symposium, orthodontic trials increased 18‐fold, and in 2005 trails had risen to 129 per year30,31.
David Sackett’s unique viewpoint and inspiration in the field of orthodontics had a significant influence on the Classic Orthodontic Class II RTCs funded by the National Institutes of Health/ National Institute of Dental and Craniofacial Research.