Uploaded December 2025 | Updated September 2026, 4 days ago
Gordon Guyatt coined the term "Evidence-Based Medicine" in 1991 and together with David Sackett and others he founded the EBM movement, formally proclaimed in the Journal of the American Medical Association (JAMA) in 1992.
He cofounded the GRADE Working Group in 2000, which has now become embedded in the World Health Organization, Cochrane, and other institutions as the authoritative distribution of EBM's influence in the world's institutions.
He started the authoritative textbook on EBM, Users Guide to the Medical Literature, in 2001, which reached its third edition in 2014 and remains the authority of the field.
As such there is no one else alive who speaks more authoritatively on what Evidence-Based Medicine truly means.
You may then be surprised that the familiar "pyramid" of the "evidence hierarchy," which appears to have been created by an entirely unknown reference librarian at SUNY Downstate in 1997, is, according to Guyatt "totally confused."
Among other reasons, properly conducted n=1 self-experiments belong at the TOP of the hierarchy, where they have appeared in the EBM textbook since 2001, remaining so in the 2014 edition. Guyatt told me that if he ever produced a fourth edition, n=1 trials would remain right at the top.
We looked together at my own randomized n=1 self-experiment comparing the impact of corn vs quinoa on my sleep and energy.
You may also be quite surprised at how Guyatt described the importance of mechanistic reasoning in interpreting the generalizability of human outcome studies. In some cases, it's "crucial."
We talked about how I synthesize mechanistic reasoning, animal studies, and human trials to interpret the way choline status should impact the effect of seed oils on fatty liver and Guyatt weighs in with his verdict on my reasoning.
In this interview, Guyatt and I discuss how to apply the principles of EBM to medicine, health and nutrition, and daily life, paying special attention to the less appreciated aspects of EBM, like the importance of individual values and choice, recognizing what we don't know, understanding the limits of generalizing from RCTs, weighing mechanistic reasoning against observational studies as means of navigating uncertainty, and how Guyatt responds to critiques from public health and to John Ioannidis's claim that EBM has been hijacked.
Gordon Guyatt coined the term "Evidence-Based Medicine" in 1991 and together with David Sackett and others he founded the EBM movement, formally proclaimed in the Journal of the American Medical Association (JAMA) in 1992.
He cofounded the GRADE Working Group in 2000, which has now become embedded in the World Health Organization, Cochrane, and other institutions as the authoritative distribution of EBM's influence in the world's institutions.
He started the authoritative textbook on EBM, Users Guide to the Medical Literature, in 2001, which reached its third edition in 2014 and remains the authority of the field.
As such there is no one else alive who speaks more authoritatively on what Evidence-Based Medicine truly means.
You may then be surprised that the familiar "pyramid" of the "evidence hierarchy," which appears to have been created by an entirely unknown reference librarian at SUNY Downstate in 1997, is, according to Guyatt "totally confused."
Among other reasons, properly conducted n=1 self-experiments belong at the TOP of the hierarchy, where they have appeared in the EBM textbook since 2001, remaining so in the 2014 edition. Guyatt told me that if he ever produced a fourth edition, n=1 trials would remain right at the top.
We looked together at my own randomized n=1 self-experiment comparing the impact of corn vs quinoa on my sleep and energy.
You may also be quite surprised at how Guyatt described the importance of mechanistic reasoning in interpreting the generalizability of human outcome studies. In some cases, it's "crucial."
We talked about how I synthesize mechanistic reasoning, animal studies, and human trials to interpret the way choline status should impact the effect of seed oils on fatty liver and Guyatt weighs in with his verdict on my reasoning.
In this interview, Guyatt and I discuss how to apply the principles of EBM to medicine, health and nutrition, and daily life, paying special attention to the less appreciated aspects of EBM, like the importance of individual values and choice, recognizing what we don't know, understanding the limits of generalizing from RCTs, weighing mechanistic reasoning against observational studies as means of navigating uncertainty, and how Guyatt responds to critiques from public health and to John Ioannidis's claim that EBM has been hijacked.
