Cohen Aaron Michael, Stavri P Zoë, Hersh William R
Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Mail Code: BICC, Portland, OR 97239-3098, USA.
Int J Med Inform. 2004 Feb;73(1):35-43. doi: 10.1016/j.ijmedinf.2003.11.002.
The major criticisms and limitations of Evidence-Based Medicine (EBM) appearing in the literature over the past decade can be summarized and categorized into five recurring themes. The themes include: reliance on empiricism, narrow definition of evidence, lack of evidence of efficacy, limited usefulness for individual patients, and threats to the autonomy of the doctor/patient relationship. Analysis of EBM according to these themes leads to the conclusion that EBM can be a useful tool, but has severe drawbacks when used in isolation in the practice of individual patient care. Modern medicine must strive to balance an extremely complex set of priorities. To be an effective aid in achieving this balance, the theory and practice of EBM must expand to include new methods of study design and integration, and must adapt to the needs of both patients and the health care system in order to provide patients with the best care at the lowest cost.
过去十年文献中出现的对循证医学（EBM）的主要批评和局限性可以总结并归类为五个反复出现的主题。这些主题包括：对经验主义的依赖、证据的狭义定义、疗效证据的缺乏、对个体患者的实用性有限，以及对医患关系自主性的威胁。根据这些主题对循证医学进行分析得出的结论是，循证医学可以是一个有用的工具，但在个体患者护理实践中单独使用时存在严重缺陷。现代医学必须努力平衡一系列极其复杂的优先事项。为了有效地帮助实现这种平衡，循证医学的理论和实践必须扩展，以纳入新的研究设计和整合方法，并且必须适应患者和医疗保健系统的需求，以便以最低的成本为患者提供最佳护理。
