Institute for History and Philosophy of Science and Technology (IHPST), Victoria College, University of Toronto, Toronto, Ontario, Canada.
J Eval Clin Pract. 2011 Oct;17(5):920-6. doi: 10.1111/j.1365-2753.2011.01727.x. Epub 2011 Aug 4.
In evidence-based medicine, randomized controlled trials are said to be the highest evidence of what works, while anecdotes have low value or are not even considered to be medical evidence. Similar hierarchical views of evidence have infected other disciplines, including evidence-based education and evidence-based government. Here, I explore the artificial divisions of acceptable from unacceptable evidence, numbers from narrative and sciences from humanities. I challenge the deprecation of stories in medicine. Some stories are based on experiments while others are based on more or less plausible theories. Some stories offer vast and impressive statistics gathered from many observations while others present one noteworthy event. Published reports are themselves stories of what experimenters did. Systematic reviewers generate their own observations of collected stories of experiments. Reviewers of systematic reviews in turn report their observations of systematic reviews. All of these stories become evidence of what works in medicine.
在循证医学中，随机对照试验被认为是最有效的证据，而传闻则价值较低，甚至不被视为医学证据。类似的证据分层观点也影响了其他学科，包括循证教育和循证政府。在这里，我探讨了可接受证据与不可接受证据、数字与叙述以及科学与人文之间的人为划分。我质疑医学中贬低故事的做法。有些故事基于实验，而有些则基于或多或少合理的理论。有些故事提供了从许多观察中收集到的广泛而令人印象深刻的统计数据，而另一些则呈现了一个值得注意的事件。已发表的报告本身就是实验者所做的故事。系统评价者对收集到的实验故事进行自己的观察。系统评价的评论者则报告他们对系统评价的观察。所有这些故事都成为了医学中有效的证据。
