University College London (UCL) (Science and Technology Studies department), London, UK.
J Eval Clin Pract. 2019 Dec;25(6):938-942. doi: 10.1111/jep.13109. Epub 2019 Feb 22.
Evidence-based medicine (EBM) calls for medical practitioners to "integrate" our best available evidence into clinical practice. A significant amount of the literature on EBM takes this integration to be unproblematic, focusing on questions like how to interpret evidence and engage with patient values, rather than critically looking at how these features of EBM can be implemented together. Other authors have also commented on this gap in the literature, for example, identifying the lack of clarity about how patient preferences and evidence from trials is supposed to be integrated in practice. In this paper, I look at this issue from an epistemological perspective, (looking at how different types of knowledge in EBM can be used to make sounds judgements). In particular, I introduce an epistemological issue for this integration problem, which I call the epistemic integration problem. This is essentially the problem of how we can use information that is both general (eg, about a population sample) and descriptive (eg, about what expected outcomes are) to reach clinical judgements that are individualized (applying to a particular patient) and normative (about what is best for their health).
循证医学（EBM）要求医疗从业者将我们现有的最佳证据“整合”到临床实践中。关于 EBM 的大量文献认为这种整合是不成问题的，主要关注如何解释证据和与患者价值观相契合的问题，而不是批判性地审视 EBM 的这些特征如何可以一起实施。其他作者也评论了文献中的这一空白，例如，明确指出在实践中应该如何整合患者偏好和临床试验证据尚不清楚。在本文中，我从认识论的角度（研究 EBM 中的不同类型的知识如何用于做出合理的判断）来看待这个问题。特别是，我为这个整合问题引入了一个认识论问题，我称之为认识论整合问题。这实质上是如何利用既具有普遍性（例如，关于人口样本）又具有描述性（例如，关于预期结果是什么）的信息来做出个体化（适用于特定患者）和规范（关于什么对他们的健康最有利）的临床判断的问题。
