Evidence-based medicine (EBM) arose as an alternative to medical expertise based on accumulated experience, physiologic reasoning, and the wisdom of august authorities, focusing initially on the critical appraisal of primary research articles. 

In its first evolution, the focus shifted toward systematic reviews of bodies of evidence addressing important clinical questions, and the recognition that evidence was never sufficient for making clinical decisions: recognition of underlying patient values and preferences is always crucial.

The next evolution involved the recognition that very few clinicians would have either the skills or the time required to evaluate primary research or even systematic reviews, and would need to rely on clinical practice guidelines.  It thus became crucial that systematic reviews that informed guidelines could provide clear ratings of certainty of evidence, and that guidelines must follow standards that would ensure trustworthiness.  GRADE as a system of achieving these goals arose in this context.

EBM’s global health focus gained prominence during the COVID-19 pandemic with the rapid production of new evidence from platform clinical trials; the lightening summarization of the evidence in living network meta-analysis; the prompt creation of practice guidelines, including those produced in collaboration with WHO; and innovative layered electronic practice summaries, including those associated with WHO guidelines.