University of Oxford, UK.
Palliat Med. 2011 Jul;25(5):394-7. doi: 10.1177/0269216310394707.
Evidence-based medicine (EBM) has, over the past 20 years, made us all more critical in our thinking about the efficacy and safety of interventions. This is evident in the higher standards of our spoken and written work, formal and informal, and in our approach to the subject. The downside has been the coincidence of the squeeze on healthcare funding with the emergence of the EBM ideas - it has been all too easy to misuse the tools of EBM to deny patients access to treatment, and this, together with the off-putting political correctness of the EBM approach in some quarters, has made clinicians uneasy. Clinicians have to make decisions about therapy for the individual patient. Ideally this is guided by the best available evidence and their experience. EBM can guide one as to the population efficacy and safety of a particular intervention, but as we all know few patients are average. That guidance can only be given if there is adequate evidence, and the difficulty with guidance about symptom control is often the paucity of evidence of sufficient quality to yield credible guidance. Palliative care is often a 'complex intervention', and here EBM struggles to untangle which components, if any, of the complex interventions are important. The trial and review methodologies for complex intervention are wanting. Tom Chalmers, a grandfather of the EBM movement, argued late in his career that the most important function of the EBM approach was to frame the research agenda. This we think is correct. The process of systematic review of a topic throws up the deficits in trial methods and the lacunae in the data, and this then can show the way forward.
循证医学（EBM）在过去的 20 年中，使我们在思考干预措施的疗效和安全性时都更加具有批判性。这一点在我们的口头和书面工作的更高标准中显而易见，无论是正式的还是非正式的，以及我们对这一主题的处理方式中都是如此。不利的一面是，医疗保健资金的紧缩与 EBM 理念的出现同时发生——很容易滥用 EBM 的工具来拒绝患者接受治疗，再加上 EBM 方法在某些方面的政治正确性让人望而却步，这让临床医生感到不安。临床医生必须为个体患者做出治疗决策。理想情况下，这是由最佳可用证据和他们的经验指导的。EBM 可以指导人们了解特定干预措施的人群疗效和安全性，但正如我们所知，很少有患者是平均水平的。只有在有足够证据的情况下才能提供这种指导，而控制症状的指导往往缺乏足够质量的证据来提供可信的指导。姑息治疗通常是一种“复杂干预”，在这种情况下，EBM 难以理清复杂干预措施中的哪些组成部分（如果有的话）是重要的。针对复杂干预的试验和审查方法存在不足。EBM 运动的祖父汤姆·查默斯（Tom Chalmers）在职业生涯的后期认为，EBM 方法最重要的功能是为研究议程提供框架。我们认为这是正确的。对一个主题进行系统审查的过程揭示了试验方法的缺陷和数据的空白，这可以为前进指明方向。
