Evidence based medicine: does it make a difference?
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《英国医生杂志》
EDITOR—The term "evidence based medicine" entered the scientific lexicon only a little more than a decade ago.1 What caused its remarkable spread, and what are the implications of its broad and rapid diffusion?
The team that coined the term at first considered using the phrase "scientific medicine" but rejected it because it implied that other approaches were by definition unscientific.2 However, critics have argued that the term evidence based medicine carries a similar moral valence and linguistic slipperiness.3 Who could argue against the notion of providing care that integrates individual clinical skill and the best external evidence?4
Originally developed as a method for teaching medical residents, evidence based medicine is being applied ever more broadly to the organisation and delivery of medical services. Multiple stakeholders now seek to assume its mantle for purposes that often contradict its original intent.
Managers, equating lack of evidence with lack of effectiveness, use it as a rationale for cutting services. Industry generates evidence of questionable quality to promote its products. Medical researchers come to believe that they hold a monopoly on generating and interpreting evidence. Evidence based medicine, developed as a means of taming the unscientific and messy world of clinical practice, has itself entered the unscientific and messy world of politics.5
Like any technology, evidence based medicine carries risks and benefits and can be used appropriately or inappropriately. Overly inclusive definitions threaten to deprive the term of meaning, and unchecked use increases the risk of misuse. In the past decade, evidence based medicine has contributed much to how we teach, deliver, and think about clinical services. In the coming decade, we must continue to ensure that it is not only used widely but wisely.
Benjamin Druss, Rosalynn Carter chair in mental health
Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA bdruss@emory.edu
Competing interests: None declared.
References
Guyatt G, Cook D, Haynes B. Evidence based medicine has come a long way. BMJ 2004;329; 990-1. (30 October.)
Guyatt G. Preface. In: Guyatt G, Rennie D. Users' guide to the medical literature. Chicago, IL: American Medical Association, 2001: xiv.
Sehon SR, Stanley DE. A philosophical analysis of the evidence-based medicine debate. BMC Health Serv Res 2003;3(1): 14.
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ 1996;312: 71-2.
Rodwin MA. The politics of evidence-based medicine. J Health Polit Policy Law 2001;26: 439-46.
The team that coined the term at first considered using the phrase "scientific medicine" but rejected it because it implied that other approaches were by definition unscientific.2 However, critics have argued that the term evidence based medicine carries a similar moral valence and linguistic slipperiness.3 Who could argue against the notion of providing care that integrates individual clinical skill and the best external evidence?4
Originally developed as a method for teaching medical residents, evidence based medicine is being applied ever more broadly to the organisation and delivery of medical services. Multiple stakeholders now seek to assume its mantle for purposes that often contradict its original intent.
Managers, equating lack of evidence with lack of effectiveness, use it as a rationale for cutting services. Industry generates evidence of questionable quality to promote its products. Medical researchers come to believe that they hold a monopoly on generating and interpreting evidence. Evidence based medicine, developed as a means of taming the unscientific and messy world of clinical practice, has itself entered the unscientific and messy world of politics.5
Like any technology, evidence based medicine carries risks and benefits and can be used appropriately or inappropriately. Overly inclusive definitions threaten to deprive the term of meaning, and unchecked use increases the risk of misuse. In the past decade, evidence based medicine has contributed much to how we teach, deliver, and think about clinical services. In the coming decade, we must continue to ensure that it is not only used widely but wisely.
Benjamin Druss, Rosalynn Carter chair in mental health
Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA bdruss@emory.edu
Competing interests: None declared.
References
Guyatt G, Cook D, Haynes B. Evidence based medicine has come a long way. BMJ 2004;329; 990-1. (30 October.)
Guyatt G. Preface. In: Guyatt G, Rennie D. Users' guide to the medical literature. Chicago, IL: American Medical Association, 2001: xiv.
Sehon SR, Stanley DE. A philosophical analysis of the evidence-based medicine debate. BMC Health Serv Res 2003;3(1): 14.
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ 1996;312: 71-2.
Rodwin MA. The politics of evidence-based medicine. J Health Polit Policy Law 2001;26: 439-46.