Mebius Alexander
Department of Philosophy and History of Technology, Royal Institute of Technology (KTH), Stockholm, Sweden.
J Eval Clin Pract. 2014 Dec;20(6):915-20. doi: 10.1111/jep.12129. Epub 2014 Apr 16.
Proponents of evidence-based medicine (EBM) have argued convincingly for applying this scientific method to medicine. However, the current methodological framework of the EBM movement has recently been called into question, especially in epidemiology and the philosophy of science. The debate has focused on whether the methodology of randomized controlled trials provides the best evidence available. This paper attempts to shift the focus of the debate by arguing that clinical reasoning involves a patchwork of evidential approaches and that the emphasis on evidence hierarchies of methodology fails to lend credence to the common practice of corroboration in medicine. I argue that the strength of evidence lies in the evidence itself, and not the methodology used to obtain that evidence. Ultimately, when it comes to evaluating the effectiveness of medical interventions, it is the evidence obtained from the methodology rather than the methodology that should establish the strength of the evidence.
循证医学（EBM）的支持者令人信服地主张将这种科学方法应用于医学。然而，EBM运动当前的方法框架最近受到了质疑，尤其是在流行病学和科学哲学领域。这场辩论聚焦于随机对照试验的方法是否能提供现有的最佳证据。本文试图转移辩论的焦点，认为临床推理涉及多种证据方法的拼凑，并且对方法证据等级的强调未能为医学中常见的确证实践提供可信度。我认为证据的强度在于证据本身，而非用于获取该证据的方法。最终，在评估医学干预的有效性时，是从方法中获得的证据而非方法本身应确定证据的强度。
