循证医学的证据特征研究及其伦理学分析  

Ethical Analysis and Study on the Evidence Characteristics of Evidence-based Medicine

作　　者：李琰[1] 李幼平[2,3] 兰礼吉[1] 喻佳洁[3] 

机构地区：[1]四川大学政治学院,四川成都610207 [2]四川大学华西医院循证医学研究中心,四川成都610041 [3]中国循证医学中心,四川成都610207

出　　处：《医学与哲学（A）》2014年第12期39-42,共4页Medicine & Philosophy:Humanistic & Social Medicine Edition

基　　金：美国中华医学基金会卫生政策循证研究合作项目(项目编号:12-095)的研究成果

摘　　要：循证医学建立的证据理念、标准和体系,是医学科学证据产生、评价、认可与使用的一般性规则,其运用于具体临床个案时不可避免地遭遇诸多质疑。通过对比传统经验医学证据与循证医学证据的区别,在证据的一般特征框架下讨论了循证医学的证据特征,整理了质疑循证医学的观点。争议表现在对随机对照试验的诸多伦理问题上;一般性证据如何用于个体患者;还有其更深层次的哲学追问:"真"的证据如何实现"善"的后果。最后指出,尽管创始时循证医学忽略了其科学哲学基础,但其发展和完善不能离开哲学支撑。The ideas,standards and system of evidence-based medicine（EBM）are general rules though which we produce,evaluate,accredit and use medical evidence.However,they have been questioned when they are applied to the specific clinical cases.This paper compared the differences between the evidences in traditional experience medicine and those in EBM,discussed the characteristics of EBM＇s evidence.Then,it cleared up the reasons which queried EBM.These arguments included many ethics controversies of random controlled trails（RCT）,how to apply general evidences to individual patients,and more profound philosophical quests on how to attain‘good＇consequence though‘real＇evidence.At last,this paper pointed out that the development and consummate of EBM cannot exist without the sustainment of philosophy.

关 键 词：循证医学 证据特征 逻辑推理 

分 类 号：R-052[医药卫生]