Kelly Michael P, Moore Tessa A
The National Institute for Health and Clinical Excellence, (NICE) , Mid City Place, 71, High Holborn, London, WC1V 6NA, UK . ; General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge .
Soc Theory Health. 2012 Feb;10(1):1-19. doi: 10.1057/sth.2011.21. Epub 2011 Dec 14.
This article describes the judgements used to interpret evidence in evidence-based medicine (EBM) and health technology assessment (HTA). It outlines the methods and processes of EBM and HTA. Respectively, EBM and HTA are approaches to medical clinical decision making and efficient allocation of scarce health resources. At the heart of both is a concern to review and synthesise evidence, especially evidence derived from randomised controlled trials (RCTs) of clinical effectiveness. The driver of the approach of both is a desire to eliminate, or at least reduce, bias. The hierarchy of evidence, which is used as an indicator of the likelihood of bias, features heavily in the process and methods of EBM and HTA. The epistemological underpinnings of EBM and HTA are explored with particular reference to the distinction between rationalism and empiricism, developed by the philosopher David Hume and elaborated by Immanuel Kant in the Critique of Pure Reason. The importance of Humian and Kantian principles for understanding the projects of EBM and HTA is considered and the ways in which decisions are made in both, within a judgemental framework originally outlined by Kant, are explored.
本文描述了用于循证医学（EBM）和卫生技术评估（HTA）中解释证据的判断方法。它概述了循证医学和卫生技术评估的方法与流程。循证医学和卫生技术评估分别是医学临床决策和有效分配稀缺卫生资源的方法。两者的核心都是关注对证据进行审查和综合，尤其是来自临床疗效随机对照试验（RCT）的证据。两者方法的驱动力都是消除或至少减少偏倚的愿望。作为偏倚可能性指标的证据等级制度在循证医学和卫生技术评估的过程与方法中具有重要地位。本文特别参考哲学家大卫·休谟提出并由伊曼努尔·康德在《纯粹理性批判》中阐述的理性主义与经验主义的区别，探讨了循证医学和卫生技术评估的认识论基础。考虑了休谟和康德原则对于理解循证医学和卫生技术评估项目的重要性，并探讨了在康德最初概述的判断框架内两者进行决策的方式。
