Djulbegovic Benjamin
Department of Interdisciplinary Oncology, University of South Florida, Tampa, Florida 33612, USA.
J Med Philos. 2007 Mar-Apr;32(2):79-98. doi: 10.1080/03605310701255719.
This paper introduces taxonomy of clinical uncertaintes and argues that the choice of scientific method should match the underlying level of uncertainty. Clinical trial is one of these methods aiming to resolve clinical uncertainties. Whenever possible these uncertainties should be quantified. The paper further shows that the still ongoing debate about the usage of "equipoise" vs. "uncertainty principle" vs. "indifference" as an entry criterion to clinical trials actually refers to the question "whose uncertainty counts". This question is intimately linked to the control of research agenda, which is not quantifiable and hence is not solvable to equal acceptability to all interested parties. The author finally shows that there is a predictable relation between [acknowledgement of] uncertainty (the moral principle) on which trials are based and the ultimate outcomes of clinical trials. That is, [acknowledgement of] uncertainty determines a pattern of success in medicine and drives clinical discoveries.
本文介绍了临床不确定性的分类，并认为科学方法的选择应与潜在的不确定性水平相匹配。临床试验是旨在解决临床不确定性的方法之一。只要有可能，这些不确定性都应进行量化。本文进一步表明，关于将“ equipoise”（平衡）、“不确定性原则”还是“无差异”用作临床试验入组标准的持续争论，实际上涉及“谁的不确定性算数”这一问题。这个问题与研究议程的控制密切相关，而研究议程是不可量化的，因此无法让所有相关方都同等接受地解决。作者最后表明，试验所基于的（对）不确定性（这一道德原则）的认知与临床试验的最终结果之间存在可预测的关系。也就是说，（对）不确定性的认知决定了医学上的成功模式并推动临床发现。
