试论循证医学的哲学基础

张越伦; 吴东; 李乃适; 刘晓清

doi:10.12290/xhyxzz.2021-0266

试论循证医学的哲学基础

doi: 10.12290/xhyxzz.2021-0266

张越伦^{1, 2},
吴东^{1, 3},
李乃适^{1, 4},
刘晓清^{1, 5, ,}

1.
中国医学科学院北京协和医学院北京协和医院临床流行病学教研室, 北京 100730
2.
中国医学科学院北京协和医学院北京协和医院医学科学研究中心, 北京 100730
3.
中国医学科学院北京协和医学院北京协和医院消化内科, 北京 100730
4.
中国医学科学院北京协和医学院北京协和医院内分泌科, 北京 100730
5.
中国医学科学院北京协和医学院北京协和医院感染内科, 北京 100730

基金项目:

中国医学科学院北京协和医学院教学课题研究生教材建设《临床研究方法》 10023201600109

详细信息

通讯作者:
刘晓清电话：010-69155087，E-mail：liuxq@pumch.cn

中图分类号: R181;B01
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- 文章访问数: 419
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- PDF下载量: 57
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出版历程
- 收稿日期: 2021-03-17
- 录用日期: 2021-04-30
- 刊出日期: 2021-05-30

Philosophical Basis of Evidence-based Medicine

ZHANG Yuelun^{1, 2},
WU Dong^{1, 3},
LI Naishi^{1, 4},
LIU Xiaoqing^{1, 5
, ,}

1.
Clinical Epidemiology Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
2.
Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
3.
Department of Gastroenterology, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
4.
Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
5.
Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

Funds:

Peking Union Medical College Educational Research Grant for Postgraduate Textbook Development 10023201600109

More Information

Corresponding author: LIU Xiaoqing Tel: 86-10-69155087, E-mail: liuxq@pumch.cn

摘要

摘要: 本文在哲学认识论的框架内探讨循证医学的哲学基础。在相当长的历史时期中，医学实践主要遵循理性推理。随着医学研究方法学的进步与发展，纯粹基于理性的医学实践开始受到质疑。循证医学将研究证据置于决策的中心地位，因此其哲学基础是经验论。然而，循证医学并未将经验论与理性绝对对立起来，正如经验论并不完全否认理性的作用，当严谨的系统性观察经验缺如时，循证医学主张应基于理性思维进行推理，由此获得的知识也可用于决策。无论是基于严谨的系统性观察经验还是理性推理进行决策，其终极目的都应使患者从医疗实践中受益。
- 循证医学 /
- 哲学 /
- 认识论 /
- 唯理论 /
- 经验论
Abstract: In this essay, we discussed the philosophical basis of evidence-based medicine regarding epistemology.Medical practice mainly has been following rational reasoning for a long period of time. However, developments of modern epidemiology call rational reasoning in medicine into question. Evidence-based medicine endorses the central role of research evidence in decision-making. Therefore, its philosophical basis should be empiricism rather than rationalism. As empiricism does not completely exclude rationality from knowledge, evidence-based medicine does not use research evidence as a "one-size-fits-all" approach and claims that decisions can be based on rationality knowledge when lacking empirical observations. No matter what philosophical basis of evidence-based medicine is, the ultimate goal should always be achieving the largest benefits for patients in medical practice.
- evidence-based medicine /
- philosophy /
- epistemology /
- rationalism /
- empiricism
注释:

作者贡献：张越伦负责撰写文章；吴东、李乃适负责修订文章；刘晓清负责审校文章。

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参考文献(38)

[1]	Snow J. On the mode of communication of cholera[M]. London: John Churchill, 1855.
[2]	詹思延. 流行病学[M]. 北京: 人民卫生出版社, 2017.
[3]	Blackburn S. The Oxford Dictionary of Philosophy[M]. Oxford: Oxford University Press, 2016.
[4]	曾志. 西方哲学导论[M]. 北京: 中国人民大学出版社, 2001.
[5]	Zalta EN, Nodelman U, Allen C, et al. Stanford encyclopedia of philosophy[M]. Palo Alto CA: Stanford University, 2005.
[6]	Kant I. Kritik der reinen Vernunft[M]. Berlin: Mayer & Muller, 1889.
[7]	Blanshard B. Rationalism. Encyclopædia Britannica[EB/OL]. (2020-05-15).[2020-11-15]. https://www.britannica.com/topic/rationalism.
[8]	Grube GMA. Meno[M]. Indianapolis: Hackett Publish-ing, 1980.
[9]	Mason JW, Peters FA. Antiarrhythmic efficacy of encainide in patients with refractory recurrent ventricular tachycardia[J]. Circulation, 1981, 63: 670-675. doi: 10.1161/01.CIR.63.3.670
[10]	Willcox JK, Ash SL, Catignani GL. Antioxidants and prevention of chronic disease[J]. Crit Rev Food Sci Nutr, 2004, 44: 275-295. doi: 10.1080/10408690490468489
[11]	Duff S, Connolly C, Buggy DJ. Adrenergic, Inflammatory, and Immune Function in the Setting of Oncological Surgery: Their Effects on Cancer Progression and the Role of the Anesthetic Technique in their Modulation[J]. Int Anesthesiol Clin, 2016, 54: 48-57. doi: 10.1097/AIA.0000000000000120
[12]	Goldstein JL, Brown MS. A century of cholesterol and coronaries: from plaques to genes to statins[J]. Cell, 2015, 161: 161-172. doi: 10.1016/j.cell.2015.01.036
[13]	Taylor F, Huffman MD, Macedo AF, et al. Statins for the primary prevention of cardiovascular disease[J]. Cochrane Database Syst Rev, 2013(1): CD004816. doi: 10.1002/14651858.CD004816.pub5/full
[14]	Chalmers I, Enkin M, Keirse MJNC. Effective Care in Pregnancy and Childbirth: Pregnancy[M]. Oxford: Oxford University Press, 1989.
[15]	Guyatt G. Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice[M]. New York: McGraw-Hill Education, 2014.
[16]	Manson JE, Cook NR, Lee IM, et al. Vitamin D Supple-ments and Prevention of Cancer and Cardiovascular Disease[J]. N Engl J Med, 2019, 380: 33-44. doi: 10.1056/NEJMoa1809944
[17]	Manson JE, Cook NR, Lee IM, et al. Marine n-3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer[J]. N Engl J Med, 2019, 380: 23-32. doi: 10.1056/NEJMoa1811403
[18]	Bjelakovic G, Nikolova D, Gluud LL, et al. Antioxidant supplements for prevention of mortality in healthy partici-pants and patients with various diseases[J]. Cochrane Database Syst Rev, 2012(3): CD007176.
[19]	Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial[J]. N Engl J Med, 1991, 324: 781-788. doi: 10.1056/NEJM199103213241201
[20]	Sessler DI, Pei L, Huang Y, et al. Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial[J]. Lancet, 2019, 394: 1807-1815. doi: 10.1016/S0140-6736(19)32313-X
[21]	Smith R. David Sackett: Physician, trialist, and teacher[J]. BMJ, 2015, 350: h2639. doi: 10.1136/bmj.h2639
[22]	The JAMA.PIERRE-CHARLES-ALEXANDRE LOUIS (1787—1872)[J]. JAMA, 1962, 182: 1330-1331. doi: 10.1001/jama.1962.03050520028011
[23]	Rothman KJ, Greenland S, Lash TL. Modern Epidemiology[M]. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2008.
[24]	U.S. Department of Health and Human Services.How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General[M/OL].[2021-03-17].https://pubmed.ncbi.nlm.nih.gov/21452462/.
[25]	Rothman KJ. Causes[J]. Am J Epidemiol, 1976, 104: 587-592. doi: 10.1093/oxfordjournals.aje.a112335
[26]	Kyzas PA, Denaxa-Kyza D, Ioannidis JPA. Almost all articles on cancer prognostic markers report statistically significant results[J]. Eur J Cancer, 2007, 43: 2559-2579. doi: 10.1016/j.ejca.2007.08.030
[27]	Anderson NL. The clinical plasma proteome: a survey of clinical assays for proteins in plasma and serum[J]. Clin Chem, 2010, 56: 177-185. doi: 10.1373/clinchem.2009.126706
[28]	Macleod MR, Michie S, Roberts I, et al. Biomedical research: increasing value, reducing waste[J]. Lancet, 2014, 383: 101-104. doi: 10.1016/S0140-6736(13)62329-6
[29]	Klemke ED, Hollinger R, Rudge DW, et al. Introductory Readings in the Philosophy of Science[M]. New York: Prometheus Books, 1998.
[30]	Godfrey-Smith P. Theory and Reality: An Introduction to the Philosophy of Science[M]. Chicago: University of Chicago Press, 2009.
[31]	Ayer AJ. Language, Truth and Logic[M]. London: Dover Publications, 2012.
[32]	Semmelweis IF, Murphy FP. The Cause, Concept and Prophylaxis of Childbed Fever[M]. Philadelphia: Lippincott Williams & Wilkins, 1941.
[33]	Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations[J]. BMJ, 2008, 336: 924-926. doi: 10.1136/bmj.39489.470347.AD
[34]	Djulbegovic B, Guyatt GH, Ashcroft RE. Epistemologic inquiries in evidence-based medicine[J]. Cancer Control, 2009, 16: 158-168. doi: 10.1177/107327480901600208
[35]	Einstein A. Zur elektrodynamik bewegter körper[J]. Annalen Der Physik, 1905, 4: 891-921. doi: 10.1002/andp.19053221004/full
[36]	Tegmark M. The interpretation of quantum mechanics: many worlds or many words?[J]. Fortschritte der Physik: Progress of Physics, 1998, 46: 855-862. doi: 10.1002/(SICI)1521-3978(199811)46:6/8<855::AID-PROP855>3.0.CO;2-Q
[37]	Gray JAM. Evidence-based healthcare[M]. Edinburgh and New York: Churchill Livingston, 2001.
[38]	PhilosophieKanal. Bertrand Russell-Message To Future Generations[EB/OL ].[2020-11-17]. https://www.youtube.com/watch?v=ihaB8AFOhZo&ab_channel=PhilosophieKanal.

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试论循证医学的哲学基础

doi: 10.12290/xhyxzz.2021-0266

通讯作者:
刘晓清电话：010-69155087，E-mail：liuxq@pumch.cn

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Philosophical Basis of Evidence-based Medicine

Corresponding author: LIU Xiaoqing Tel: 86-10-69155087, E-mail: liuxq@pumch.cn

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试论循证医学的哲学基础

doi: 10.12290/xhyxzz.2021-0266

通讯作者: 刘晓清 电话：010-69155087，E-mail：liuxq@pumch.cn

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出版历程

Philosophical Basis of Evidence-based Medicine

Corresponding author: LIU Xiaoqing Tel: 86-10-69155087, E-mail: liuxq@pumch.cn

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出版历程

目录

通讯作者:
刘晓清电话：010-69155087，E-mail：liuxq@pumch.cn