基于证据的医学破产了吗?

伦敦—基于证据的医学,如大卫·萨克特(David Sackett)及其同事在1996年所写,“有意识地、明确地、明智地使用当下最佳证据做出个体病人的医疗方案。”乍一看,这完全合乎逻辑;事实上,有许多人都说,这已足以称为“医学”。但这一方法正在引起巨大的争议,许多人认为它已“破产”。上个月,《英国医学杂志》(British Medical Journal)做了一次读者调查,询问基于证据的医学是否出了问题,回答几乎是五五开:51%的人表示肯定,49%的人表示否定。

争议来自什么样的证据被使用。萨克特暗示(但并不确定)流行病学证据(从随机控制实验和多年期大群体研究中发现)应该成为医生诊疗病人的决策基础——人们希望咨询病情亦是如此。

流行病学研究回答类似于这样的问题:“如果1,000个患有2型糖尿病的人随机地分为四个组,每组250人并在十年的时间里分别不治疗(或使用安慰剂)、使用药物A、使用药物B和使用药物C,存活率将会受到什么影响?副作用和并发症(如有)情况又会如何?”如果实验设计合理——规模足够大、人群真正以随机方式分组、结果为“盲”测——那么其结果应该是可靠的。

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