Principles of evidence-based medicine: from Robert Koch’s postulates to a current EBM concept

Summary

The aim of the article is to describe the development of the principles of medicine based on the evidence (EBM) based on postulates of Robert Koch, Nobel prize winner, protagonist of the "Golden Age" medical bacteriology, founder of a concept of modern microbiology and infectology. Kochs’ work led to the discovery of a causal relationship between exposure to a specific pathogen and disease on the example of identifying the cause of anthrax – Bacillus anthracis, a disease whose symptoms vary depending on the mode of transmission (gastrointestinal ingestion, cutaneous form on contact and pulmonary manifestations when inhaled). Tuberculosis caused by Koch’s bacillus, Mycobacterium tuberculosis, yet still affecting 1.7 billion people (about 25 % of the world's population), in 95 % of cases in developing countries, where poverty and high prevalence of HIV are part of everyday life. Koch also discovered Vibrio cholerae, the pathogen responsible for seven recorded pandemics, and hitherto sporadic epidemics in recent years.

The main contribution of the Kochs’ four postulates formulation was the principle, which helped to reveal the causal relationship between the pathogenic microbe to protrude infectious disease and obtain reliable evidence in improving credibility of diagnosis of infectious diseases.

Other stages in the development of EBM were formulated by Bradford Hill in his nine principles, which are valid as well for noncommunicable diseases. The subjects of discussion are limitations and restrictions of present EBM and its essentials and the use in rational preventive, diagnostic and treatment strategies.

Keywords:

Evidence based medicine – EBM – Robert Koch – Bradford Hill – causality – infectious diseases – noncommunicable diseases – four postulates – nine principles