涵盖科学观与人文观的循证医学发展——兼谈循证中医药学科的未来前景
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摘要
科学与人文是医学发展中的两种主要观念,贯穿于医学的理论及实践。在现代"生物-心理-社会"医学理念引领下,医学的科学观与人文观达到了空前的发展水平和融合状态,共同决定了当前医学的内涵和需求。作为目前主流的医学模式之一,循证医学在当前医学理论及实践的管理中发挥了重要作用,同时在自身发展中涵盖了科学与人文观念,成功塑造了循证知识方法体系。循证医学将继续洞察未来医学科学观与人文观的特征,尤应重视人文观理念与方法的发展,不断更新完善。循证中医药学作为循证医学的一个重要分支,有可能成为科学观与人文观完美结合的典范。
Scientism and humanism are two main views on the development of medicine, which run through both theory and practice. Under the guidance of the modern medical concept of "bio-psycho-social", the views of scientism and humanism on medicine have reached an unprecedented level of development and integration, which jointly determine the connotations and demands of current medicine. As one of the current mainstream medical models, evidence-based medicine(EBM) has played an important role in the management of current medical theories and practices. Meanwhile, EBM has also encompassed views of scientism and humanism in its own development and has successfully shaped the knowledge and methodological system. EBM will continue to gain insight into the characteristics of views of scientism and humanism in the future of medicine to improve itself and should pay more attention to the development of humanism view. As an important branch discipline of EBM, evidence-based Chinese medicine may become a model of the perfect combination of scientism view and humanism view.
Scientism and humanism are two main views on the development of medicine, which run through both theory and practice. Under the guidance of the modern medical concept of "bio-psycho-social", the views of scientism and humanism on medicine have reached an unprecedented level of development and integration, which jointly determine the connotations and demands of current medicine. As one of the current mainstream medical models, evidence-based medicine(EBM) has played an important role in the management of current medical theories and practices. Meanwhile, EBM has also encompassed views of scientism and humanism in its own development and has successfully shaped the knowledge and methodological system. EBM will continue to gain insight into the characteristics of views of scientism and humanism in the future of medicine to improve itself and should pay more attention to the development of humanism view. As an important branch discipline of EBM, evidence-based Chinese medicine may become a model of the perfect combination of scientism view and humanism view.
引文
1李忠民,孙振球.循证医学中的科学人文精神.中国循证医学杂志, 2005, 5(10):804-806.
2 邱晓晓,戴雍月,李银苹,等.将循证医学和人文理念引入医学PBL教学的必要性分析与探索.教育教学论坛, 2016,(32):178-179.
3段碧芳,刘建平.中医人文特征与循证医学评价方法.中医杂志,2007, 48(2):314-316.
4 白融,白虹.中世纪医学教育与经院哲学-兼论医学生人文精神培育的内涵.医学与哲学, 2014,(3):77-80.
5郭建.现代医学技术的异化及其哲学反思.合肥:中国科学技术大学, 2017.
6 World health organization. Frequently asked questions, 2018.Available at:http://www.who.int/suggestions/faq/en/.
7杜亮,李幼平. Archie Cochrane-Cochrane系统评价的倡导者.中国循证医学杂志, 2005, 5(2):174-176.
8 Cochrane AL, Holland WW. Validation of screening procedures.Br Med Bull, 1971, 27(1):3.
9Cochrane AL, Leger ASS, Moore F. Health service’input’and mortality’output’in developed countries. J Epidemiol Community Health, 1978, 32(3):200-205.
10 Evidence-Based Medicine Working Group. Evidence based medicine:a new approach to teaching the practice of medicine.JAMA, 1992, 268(17):2420-2425.
11Guyatt GH, Rennie D. Users’Guides to the medical literature:a manual for evidence-based clinical practice. Chicago:AMA Press.2002:12-13.
12 Sackett DL, Straus SE, Richardson WS, et al. How to practice and teach EBM. 2nd edition. Edinburgh:Churchill Livingstone, 2000.
13Schulz KF, Altman DG, Moher D. CONSORT 2010 statement:updated guidelines for reporting parallel group randomized trials.Ann Intern Med, 2010, 152(11):726-732.
14 Moher D, Liberati A, Tetzlaff J, et al.系统评价和Meta分析优先报告的条目:PRISMA声明.中西医结合学报, 2009, 18(3):e123.
15Elm EV, Altman DG, Egger M, et al. Strengthening the reporting of observational studies in epidemiology(STROBE)statement:guidelines for reporting observational studies. BMJ, 2008,336(7634):35-35.
16 Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary? Control Clin Trials, 1996, 17(1):1-12.
17Shea B, Grimshaw M, Wells GA, et al. Development of AMSTAR:a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7(1):1-7.
18 Wells GA, Shea B, O’connell D, et al. The Newcastle-Ottawa scale(NOS)for assessing the quality of nonrandomized studies in metaanalyses. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
19柴丽菊,高淑贤,许永顺,等.循证护理中人文关怀在心血管介入诊疗中的影响分析.山西医药杂志, 2017, 46(18):2253-2255.
20 Cheng CW, Wu TX, Shang HC, et al. CONSORT extension for Chinese herbal medicine formulas 2017:recommendations,explanation, and elaboration. Ann Intern Med, 2017, 167(2):112-121.
21Pandis N, Fleming PS, Hopewell S, et al. The CONSORT statement:application within and adaptations for orthodontic trials. Am J Orthod Dentofacial Orthop, 2015, 147(6):663-679.
22Montgomery P, Grant S, Mayo-Wilson E, et al. Reporting randomised trials of social and psychological interventions:the CONSORT-SPI 2018 Extension. Trials, 2018, 19(1):407.
23 杨文登.循证医学的哲学反思及其对人文社会科学实践的启示.循证医学, 2010, 10(1):49-53.
24Charon R. Narrative medicine:form, function, and ethics. Ann Intern Med, 2001, 134(1):83-87.
25张晓雨,陈诗琪,李承羽,等.循证中医药学理论研究与应用实践.中国循证医学杂志, 2018, 18(1):86-91.
2 邱晓晓,戴雍月,李银苹,等.将循证医学和人文理念引入医学PBL教学的必要性分析与探索.教育教学论坛, 2016,(32):178-179.
3段碧芳,刘建平.中医人文特征与循证医学评价方法.中医杂志,2007, 48(2):314-316.
4 白融,白虹.中世纪医学教育与经院哲学-兼论医学生人文精神培育的内涵.医学与哲学, 2014,(3):77-80.
5郭建.现代医学技术的异化及其哲学反思.合肥:中国科学技术大学, 2017.
6 World health organization. Frequently asked questions, 2018.Available at:http://www.who.int/suggestions/faq/en/.
7杜亮,李幼平. Archie Cochrane-Cochrane系统评价的倡导者.中国循证医学杂志, 2005, 5(2):174-176.
8 Cochrane AL, Holland WW. Validation of screening procedures.Br Med Bull, 1971, 27(1):3.
9Cochrane AL, Leger ASS, Moore F. Health service’input’and mortality’output’in developed countries. J Epidemiol Community Health, 1978, 32(3):200-205.
10 Evidence-Based Medicine Working Group. Evidence based medicine:a new approach to teaching the practice of medicine.JAMA, 1992, 268(17):2420-2425.
11Guyatt GH, Rennie D. Users’Guides to the medical literature:a manual for evidence-based clinical practice. Chicago:AMA Press.2002:12-13.
12 Sackett DL, Straus SE, Richardson WS, et al. How to practice and teach EBM. 2nd edition. Edinburgh:Churchill Livingstone, 2000.
13Schulz KF, Altman DG, Moher D. CONSORT 2010 statement:updated guidelines for reporting parallel group randomized trials.Ann Intern Med, 2010, 152(11):726-732.
14 Moher D, Liberati A, Tetzlaff J, et al.系统评价和Meta分析优先报告的条目:PRISMA声明.中西医结合学报, 2009, 18(3):e123.
15Elm EV, Altman DG, Egger M, et al. Strengthening the reporting of observational studies in epidemiology(STROBE)statement:guidelines for reporting observational studies. BMJ, 2008,336(7634):35-35.
16 Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary? Control Clin Trials, 1996, 17(1):1-12.
17Shea B, Grimshaw M, Wells GA, et al. Development of AMSTAR:a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7(1):1-7.
18 Wells GA, Shea B, O’connell D, et al. The Newcastle-Ottawa scale(NOS)for assessing the quality of nonrandomized studies in metaanalyses. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
19柴丽菊,高淑贤,许永顺,等.循证护理中人文关怀在心血管介入诊疗中的影响分析.山西医药杂志, 2017, 46(18):2253-2255.
20 Cheng CW, Wu TX, Shang HC, et al. CONSORT extension for Chinese herbal medicine formulas 2017:recommendations,explanation, and elaboration. Ann Intern Med, 2017, 167(2):112-121.
21Pandis N, Fleming PS, Hopewell S, et al. The CONSORT statement:application within and adaptations for orthodontic trials. Am J Orthod Dentofacial Orthop, 2015, 147(6):663-679.
22Montgomery P, Grant S, Mayo-Wilson E, et al. Reporting randomised trials of social and psychological interventions:the CONSORT-SPI 2018 Extension. Trials, 2018, 19(1):407.
23 杨文登.循证医学的哲学反思及其对人文社会科学实践的启示.循证医学, 2010, 10(1):49-53.
24Charon R. Narrative medicine:form, function, and ethics. Ann Intern Med, 2001, 134(1):83-87.
25张晓雨,陈诗琪,李承羽,等.循证中医药学理论研究与应用实践.中国循证医学杂志, 2018, 18(1):86-91.