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医疗保健中的验证与信任。

Verification and trust in healthcare.

作者信息

Jesudason Edwin

机构信息

Rehabilitation Medicine, NHS Lothian, Edinburgh, UK

出版信息

J Med Ethics. 2023 Mar;49(3):223-224. doi: 10.1136/jme-2022-108634. Epub 2022 Nov 1.

Abstract

'Trust but verify' is a translation of a Russian proverb made famous by former US President Ronald Reagan. In their paper, Graham appear to take an alternate view that might be summarised as The contrast highlights a general question: how do we come to trust in authorities? More specifically, Graham claim: (1) that UK Trusted Research Environments (TREs) are misnamed as future custodians for big health data because their promised verification systems actually negate the uncertainty that trust requires; (2) the public is mistaken if it believes such verification enhances trust; (3) the notion of building public trust in TREs is unclear or misconceived. In response, I propose a more relational, perhaps less reductionist account. I argue (1) that verification is itself a source of uncertainty, so it can't extinguish the uncertainty needed for trust; (2) it's nevertheless possible for verification to enhance feelings of trust thereby reducing our needs for the same; (3) trust is also social, even political, meaning institutions like TREs may become too big to fail-and end up shielding their 'trusted' brand by being less candid about inevitable flaws in their verification systems.

摘要

“信任但要核实”是美国前总统罗纳德·里根使之闻名的一句俄罗斯谚语的翻译。在他们的论文中,格雷厄姆似乎持有另一种观点,可概括为:这种对比凸显了一个普遍问题:我们如何开始信任权威?更具体地说,格雷厄姆声称:(1)英国的可信研究环境(TREs)被错误地命名为未来大型健康数据的保管者,因为其承诺的核实系统实际上消除了信任所需的不确定性;(2)如果公众认为这种核实能增强信任,那他们就错了;(3)在可信研究环境中建立公众信任的概念不明确或被误解。作为回应,我提出一种更具关联性、或许不那么简化的解释。我认为:(1)核实本身就是不确定性的一个来源,所以它无法消除信任所需的不确定性;(2)然而,核实仍有可能增强信任感受,从而减少我们对信任的需求;(3)信任也是社会性的,甚至是政治性的,这意味着像可信研究环境这样的机构可能会变得太大而不能倒闭——最终通过对其核实系统中不可避免的缺陷不那么坦诚来保护其“可信”的声誉。

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