Devries Raymond G
Center for Bioethics, University of Minnesota, Minneapolis 55455-0346, USA.
Int J Health Serv. 2004;34(4):595-623. doi: 10.2190/RR53-WQ0A-W528-TYCE.
Most critiques of evidence-based medicine (EBM) focus on the scientific shortcomings of the technique. Social scientists are more likely to criticize EBM for its ideological biases, a criticism that makes sociological sense but is difficult to substantiate. Using evidence from the scientific debate over maternity care in the Netherlands--where nearly one-third of births take place at home--the author shows that research evidence is the product of a researcher's assumptions about the practice in question. In the case of maternity care in the Netherlands, ideological differences about the most appropriate way to give birth--based in the researcher's clinical experience--give rise to irresolvable disagreements about what constitutes evidence and how that evidence is to be interpreted. "Evidence" cannot settle scientific disputes in any simple way. Rather, it becomes a rhetorical justification for whatever particular groups were going to do anyway. Scientific evidence rests on clinical practice, which in turn is rooted in structural arrangements and cultural ideas.
大多数对循证医学（EBM）的批评都集中在该技术的科学缺陷上。社会科学家更倾向于批评循证医学存在意识形态偏见，这种批评在社会学上有一定道理，但难以证实。作者利用荷兰关于孕产妇护理的科学辩论中的证据——荷兰近三分之一的分娩在家中进行——表明研究证据是研究者对相关实践的假设的产物。就荷兰的孕产妇护理而言，基于研究者临床经验的关于最适当分娩方式的意识形态差异，导致了在什么构成证据以及如何解释该证据方面无法解决的分歧。“证据”无法以任何简单的方式解决科学争端。相反，它成为了无论特定群体原本打算做什么的一种修辞性理由。科学证据基于临床实践，而临床实践又植根于结构安排和文化观念。
