SGEM Xtra: Carl Heneghan – Legend of Evidence-Based Medicine - The Skeptics Guide to Emergency Medicine

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Date: March 4, 2026

Guest Skeptic: Prof Carl Heneghan is a General Practitioner, Professor of Evidence-Based Medicine at the University of Oxford and current Director of the Centre for Evidence-Based Medicine (CEBM).

Today, we’re launching a brand-new SGEM series: Legends of Evidence-Based Medicine (EBM). In the past, I’ve interviewed legends of Emergency Medicine: Dr. Diane Birnbaumer, Dr. Ian Stiell, Dr. Jerome Hoffman, Dr. Joe Lex, Dr. Richard Bukata, Dr. Andrew Worster and Dr. Judith Tintinalli. But today, we pivot to the people who shaped how we think about evidence itself.

I first met Carl back in 2012 when I took the Teaching Evidence-Based Practice course at Oxford. That experience directly inspired the SGEM as a knowledge translation project. So, in many ways, the SGEM is Carl’s fault.

Before we start the formal part of the podcast, Carl and I discussed what it is like to be recording this SGEM episode on location at the University of Oxford. The place with cobblestone streets, spires, Latin inscriptions, and the occasional person in academic robes- basically, it’s Hogwarts.

Five Questions for Professor Heneghan

Professor Heneghan

1) The Superhero Origin Story

What got you interested in evidence-based medicine?
How did your training as a GP influence your thinking?
Was there tension at the time between traditional authority and emerging EBM?
What was Oxford like during the early years of the EBM movement (late 1990s)?

2) Contribution to EBM

When you look back on your career, what do you think you’ve contributed to the evolution of EBM?
What are you trying to change as the director of the CEBM?
Why is transparency such a foundational issue?
Do you think we’ve improved trial reporting meaningfully over the last 20-30 years?

One of the things I’ve always admired about Carl’s work is that he doesn’t just “use” evidence; he questions whether the evidence itself is trustworthy. This is something he talks about on his Substack: Trust the Evidence. It is described as a couple of old geezers writing about the evidence.

3) The Critics (Haters Gonna Hate)

EBM hasn’t been without controversy. Some of the criticisms have involved being cookbook medicine, having too much pharma influence (hijacked), being overly reductionist, using a hierarchy of evidence (pyramid) while dismissing mechanistic evidence, being too focused on randomized controlled trials (gold-standard), being dismissive of clinical expertise and ignoring patients’ values/preferences. Some have suggested we need to go to EBM+.

Has EBM ever drifted away from its original intent, promoted by Dr. Sackett and Dr. Guyatt?
Are we sometimes confusing guidelines with GODlines?
One of my mentors, Dr. Jerry Hoffman pushed back about EBM and said…Do we need an RCT for everything, like looking both ways before crossing the street?
Do we sometimes forget patient values in the process?

EBM was never meant to replace clinical expertise; it was meant to make it more disciplined.

4) The Future of EBM

Let’s fast-forward 30 years: what does evidence-based medicine look like in 2056?
My DPhil is looking at how artificial intelligence can be used ethically and responsibly to improve EBM. What are your thoughts on AI & do you think it strengthens EBM or undermines it?
Will systematic reviews become living, real-time documents?

5) Future EBM Leaders

Who are the future leaders of EBM?
What qualities do you think matter most in the next generation of EBM practitioners?
What advice would you give a trainee who wants to shape the future of evidence?

The SGEM will be back next episode with a structured critical appraisal of a recent publication. Trying to cut the knowledge translation window from over ten years to less than one with the power of social media.