Smith R
British Medical Journal, London.
BMJ. 1992 Nov 21;305(6864):1284-7. doi: 10.1136/bmj.305.6864.1284.
Many clinical decisions have to be taken with inadequate scientific information. Reaching a consensus among experts has been tried as one response to this problem. Another, described here, is to use legal process to dissect a difficult question. In this case a mock trial--using barristers, expert witnesses, and a jury--was conducted on whether bone marrow transplantation should be offered to all children with symptomatic sickle cell disease. Transplantation seems to offer about a 90% cure rate for a condition that may kill 15% of children before they reach 20. But transplantation carries a 10% risk of death or severe disability, and doctors cannot predict which children will suffer severely from their sickle cell disease and which will suffer little or nothing. The jury eventually reached a majority decision that transplantation should not be offered now to all symptomatic children.
许多临床决策是在科学信息不足的情况下做出的。让专家达成共识已被尝试作为解决这一问题的一种方式。这里描述的另一种方式是利用法律程序剖析一个难题。在这种情况下，针对是否应该为所有有症状的镰状细胞病患儿提供骨髓移植进行了一场模拟审判，参与者包括大律师、专家证人以及一个陪审团。对于一种可能导致15%的儿童在20岁前死亡的疾病，移植似乎能提供约90%的治愈率。但移植有10%的死亡或严重残疾风险，而且医生无法预测哪些儿童会因镰状细胞病而严重受苦，哪些儿童只会有轻微症状或毫无症状。陪审团最终达成多数决定，即目前不应为所有有症状的儿童提供移植。
