Gaeta Rodolfo, Gentile Nelida
Departamento de Filosofia, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
J Eval Clin Pract. 2016 Aug;22(4):550-7. doi: 10.1111/jep.12419. Epub 2015 Jul 21.
The purpose of this paper is to develop some thoughts on philosophical issues surrounding evidence-based medicine (EBM), especially related to its epistemological dimensions. After considering the scope of several philosophical concepts that are relevant to the discussion, and drawing some distinctions among different aspects of EBM, we evaluate the status of EBM and suggest that EBM is mainly a meta-methodology. Then, we outline an evaluation of the thesis that EBM is a 'new paradigm' in the practice of medicine. We argue that EBM does not seem to have arisen in the way Kuhn imagined paradigms to arise but as a conscious, deliberate proposal, more as programme than as a reality. Furthermore, there is something paradoxical about appealing to evidence or to the best evidence as a way of promoting a new paradigm. For the proposal seems to assume that there is something that by its own virtue is the best evidence for a given time. But this idea would have been rejected by Kuhn. If EBM involves a genuine new alternative in the field of medicine and shows a way in which the discipline will endure henceforth, this indicates that it is not what Kuhn once called a 'paradigm' and even, paradoxically, it is good evidence that scientific paradigms do not exist, at least in medicine.
本文旨在对循证医学（EBM）相关的哲学问题展开一些思考，尤其是其认识论层面的问题。在考量了与该讨论相关的几个哲学概念的范畴，并对循证医学的不同方面进行区分之后，我们评估了循证医学的地位，并认为循证医学主要是一种元方法。然后，我们概述了对循证医学是医学实践中的“新范式”这一论点的评估。我们认为，循证医学似乎并非以库恩所设想的范式出现的方式产生，而是作为一种有意识、经过深思熟虑的提议出现的，更像是一个纲领而非现实。此外，将证据或最佳证据作为推动新范式的一种方式存在一些自相矛盾之处。因为该提议似乎假定在特定时期存在某种自身即为最佳证据的东西。但库恩会拒绝这种观点。如果循证医学在医学领域涉及一种真正的新选择，并表明了该学科今后将持续发展的一种方式，这表明它并非库恩曾经所称的“范式”，甚至自相矛盾的是，这有力地证明了科学范式并不存在，至少在医学领域是这样。
