In 1972, David Eddy, then 31 years old and halfway through a residency in cardiovascular surgery at Stanford University, made a rather uncomfortable personal discovery, one that would change his life forever. Though his father, grandfather and great-grandfather all were physicians, Eddy, himself, realized that while he loved the idea of healing people, the actual business of surgery didn't excite him at all. In fact, it repelled him. It was too imperfect an art, he thought, too grounded in arbitrary judgments rather than hard facts.

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After witnessing a particularly grueling, unsuccessful surgery as an intern that year, Eddy recalls, he made the bold decision to drop out of his residency program. At best, life-and-death judgments were far too subjective, Eddy reasoned—yet rarely did people question a doctor's decisions, regardless of how uninformed by data. "I would go into the [medical] literature to get the probabilities of how various treatments would turn out, but I couldn't find any numbers whatsoever," Eddy recalls. Instead, he says, he'd find "a series of dictatorial statements suggesting that if a patient has a particular ailment such as a breast lump, then you do treatment X. There was no weighing of benefits or harms. What physicians were doing back then was following simple if-then rules."

And that was just the half of it, Eddy says: Too little was known about patients—how the combination of their unique histories, their lifestyles, their hereditary backgrounds, along with the quality of physician care and specific medical interventions, all had a bearing on one other. Yet doctors were making serious treatment decisions without fully recognizing these interactions. "The lack of accountability to data was astounding," says Eddy. There had to be a better way, he thought. "I realized, quite dreadfully," he says, "that this haphazard approach made it depressing for me to be around sick people." Indeed, Eddy told a local medical society: "The intellectual foundation of medical care is based on the assumption that whatever a physician decides is, by definition, correct. While many decisions are, no doubt, correct, many are not, and elaborate mechanisms are needed to determine which are which."