Hansen Kirsten, Kappel Klemens
Department of Public Health, Section for Health Services Research, Oester Farimagsgade 5, Building 9, PO Box 2099, DK-1014 Copenhagen K, Denmark.
J Med Philos. 2010 Feb;35(1):7-18. doi: 10.1093/jmp/jhp059. Epub 2009 Dec 21.
In this article we explore the role evidence ought to play in complementary and alternative medicine (CAM). First, we consider the claim that evidence in the form of randomized controlled trials (RCTs) cannot be obtained for CAMs. Second, we consider various claims to the effect that there are ways of obtaining evidence that do not make use of RCTs. We argue that there is no good reason why CAM should be exempted from the general requirement that treatments undergo evaluation by RCT. Third, we consider two implications for health care policy. First, many activities in conventional medicine have never been rigorously evaluated and are widely in use nonetheless. We argue that this fails to provide a reason for exempting CAM from a demand for evidence. Second, CAM use may be compared to a choice of lifestyle, and this has a significant impact on which requirements of evidence can reasonably be imposed.
在本文中，我们探讨了证据在补充和替代医学（CAM）中应发挥的作用。首先，我们考虑这样一种说法，即无法获得以随机对照试验（RCT）形式存在的补充和替代医学证据。其次，我们考虑各种说法，大意是存在不使用随机对照试验来获取证据的方法。我们认为，没有充分的理由使补充和替代医学免受治疗需通过随机对照试验进行评估这一普遍要求的约束。第三，我们考虑对医疗保健政策的两个影响。其一，传统医学中的许多活动从未经过严格评估，但仍被广泛使用。我们认为，这并不能成为免除补充和替代医学提供证据要求的理由。其二，使用补充和替代医学可与生活方式的选择相比较，这对合理施加何种证据要求有重大影响。
