Chin-Yee Benjamin H
Faculty of Medicine, Institute for the History and Philosophy of Science and Technology, University of Toronto, Toronto, Ontario, Canada.
J Eval Clin Pract. 2014 Dec;20(6):921-7. doi: 10.1111/jep.12258. Epub 2014 Nov 19.
This article explores the philosophical implications of evidence-based medicine's (EBM's) epistemology in terms of the problem of underdetermination of theory by evidence as expounded by the Duhem-Quine thesis. EBM hierarchies of evidence privilege clinical research over basic science, exacerbating the problem of underdetermination. Because of severe underdetermination, EBM is unable to meaningfully test core medical beliefs that form the basis of our understanding of disease and therapeutics. As a result, EBM adopts an epistemic attitude that is sceptical of explanations from the basic biological sciences, and is relegated to a view of disease at a population level. EBM's epistemic attitude provides a limited research heuristic by preventing the development of a theoretical framework required for understanding disease mechanism and integrating knowledge to develop new therapies. Medical epistemology should remain pluralistic and include complementary approaches of basic science and clinical research, thus avoiding the limited epistemic attitude entailed by EBM hierarchies.
本文从迪昂-奎因论题所阐述的证据对理论的不充分决定性问题出发，探讨循证医学（EBM）认识论的哲学意蕴。循证医学的证据等级体系赋予临床研究高于基础科学的特权，加剧了不充分决定性问题。由于严重的不充分决定性，循证医学无法对构成我们理解疾病和治疗基础的核心医学信念进行有意义的检验。结果，循证医学采取了一种对基础生物科学解释持怀疑态度的认知态度，并局限于对疾病的群体层面的看法。循证医学的认知态度通过阻碍理解疾病机制和整合知识以开发新疗法所需的理论框架的发展，提供了一种有限的研究启发法。医学认识论应保持多元化，包括基础科学和临床研究的互补方法，从而避免循证医学证据等级体系所带来的有限认知态度。
