Jenicek Milos
Department of Clinical Epidemiology and Biostatistics at McMaster University, Hamilton, Ontario, Canada.
J Eval Clin Pract. 2006 Aug;12(4):410-9. doi: 10.1111/j.1365-2753.2006.00718.x.
In the past 14 years, Evidence-Based Medicine (EBM) has enjoyed unprecedented developments and gained widespread acceptance among health professionals. However, should we be content with producing, critically appraising and using the best evidence available for our understanding of health problems and decision making about them? Are our convictions about EBM's relevance, our conviction and intellectual satisfaction with its mastery and adoption enough? Should we continue pushing forward along this promising path, or should we further diversify the content and scope of EBM? Is EBM the only way to view medicine in the near future? This paper presents some options to choose from in terms of direction and content as well as questions to answer given the current EBM crossroads. More intensive and extensive EBM combined with 'other features'-based medicines may be the preferred strategy to follow in the future to determine the development, use and evaluation of EBM. Argument-based medicine or Reasoned Medicine is one of the options that can be integrated into the mainstream of medical reasoning and decision making.
在过去的14年里，循证医学（EBM）取得了前所未有的发展，并在卫生专业人员中得到了广泛认可。然而，我们是否应该满足于生产、批判性评价和使用现有的最佳证据来理解健康问题并据此做出决策？我们对循证医学相关性的信念，以及对掌握和采用循证医学的信念和智力满足感是否足够？我们应该继续沿着这条充满希望的道路前进，还是应该进一步使循证医学的内容和范围多样化？在不久的将来，循证医学是看待医学的唯一方式吗？本文提出了一些在方向和内容方面可供选择的方案，以及鉴于当前循证医学的十字路口需要回答的问题。未来，更深入、更广泛的循证医学与基于“其他特征”的医学相结合，可能是确定循证医学发展、使用和评估的首选策略。基于论证的医学或理性医学是可以融入医学推理和决策主流的选择之一。
