The "parachute paradigm" is a famous analogy in evidence-based medicine introduced in a 2003 article in the British Medical Journal (BMJ) by Smith and Pell. The argument is that certain interventions, like using a parachute when jumping from an airplane, have such an overwhelmingly large effect (reducing fatality from nearly 100% to almost zero) that conducting randomized controlled trials (RCTs) to prove their efficacy would be ludicrous and unethical. The parachute is used to illustrate that not all medical practices require the same level of experimental evidence to justify their use.

However, this analogy is mostly tongue-in-cheek and seldom applicable in real medicine. Most medical interventions do not have such dramatic and guaranteed effects as a parachute. In fact, subsequent analyses showed that many practices claimed to be "parachutes" have undergone RCTs with mixed results, and only very few medical interventions have effects as large as a parachute's life-saving capacity. The parachute paradigm highlights the limits of strict reliance on RCTs but also warns against dismissing trials altogether because a perceived effect seems obvious.

The story of Evidence-Based Medicine (EBM) begins with its formal naming in the early 1990s, although its roots span back centuries. The term "evidence-based medicine" was coined by Gordon Guyatt in 1991 at McMaster University in Canada, marking a shift toward using scientific research in clinical decision-making rather than relying solely on intuition or unsystematic experience. EBM was defined as the conscientious, explicit, and judicious use of current best evidence from clinical research to guide individual patient care.

The modern era of EBM began in the 1970s, notably influenced by Professor Archie Cochrane in the UK, who criticized the lack of systematic evaluation of treatments and advocated for rigorous research-based clinical decisions. This led to the creation of the Cochrane Collaboration in 1993, which organizes systematic reviews of randomized controlled trials to inform healthcare practice globally.

In psychological treatments, the evidence-based approach developed more recently, emphasizing rigorous scientific evaluation of psychotherapy effectiveness. Historically, therapies were based mainly on clinical theory and observation, but since the last few decades, psychological interventions have increasingly been validated through randomized trials and meta-analyses. Cognitive-Behavioral Therapy (CBT) became one of the earliest and most well-established evidence-based psychological treatments.

In summary, both medicine and psychological treatment shifted toward evidence-based practice, integrating the best research evidence with clinical expertise and patient values, to improve outcomes and standardize effective care

Archibald Cochrane

Archibald "Archie" Cochrane (1909–1988) is widely recognized as one of the fathers of modern evidence-based medicine (EBM). His landmark contribution was to highlight the lack of reliable scientific evidence supporting many commonly used medical treatments. In 1972, while director of the Medical Research Council Epidemiology Research Unit in Cardiff, Cochrane published the influential book "Effectiveness and Efficiency: Random Reflections on Health Services", which criticized the medical community for not systematically evaluating the efficacy of treatments through rigorous research. He called for a more scientific approach to medicine based on randomized controlled trials and systematic reviews.

Cochrane's vision of gathering and critically assessing all available evidence to guide clinical practice inspired the establishment of the Cochrane Collaboration in 1993, an international organization dedicated to producing systematic reviews of clinical trials to inform healthcare decisions. This collaboration today is a cornerstone of the global evidence-based medicine movement.

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