循证医学的科学观和人文观
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摘要
循证医学坚持"从临床问题出发,将医生的临床技能、经验与当前可得的最佳证据结合,同时综合考虑患者价值观、意愿及临床环境后,做出最佳医疗决策",其本质是科学哲学在评价医疗假说中的一种具体应用,也体现了人文关怀在医疗活动中的重要地位。本文尝试从哲学角度阐释循证医学的科学和人文特性,以推动循证医学的思维模式在医学及其他领域的广泛应用。
The primary principle of evidence-based medicine is that the best clinical decision-making is derived from clinical problems with combination of patient's preferences with clinical experience and the best evidence.Evidence-based medicine by its nature, is a specific application on the evaluation of medical hypothesis. It also emphasize the importance of humanism in clinical practice. Our study explored the scientific and humanistic characteristics of evidence-based medicine from the prospective of philosophy, so as to facilitate the extensive application of evidence based practice paradigm in other fields.
The primary principle of evidence-based medicine is that the best clinical decision-making is derived from clinical problems with combination of patient's preferences with clinical experience and the best evidence.Evidence-based medicine by its nature, is a specific application on the evaluation of medical hypothesis. It also emphasize the importance of humanism in clinical practice. Our study explored the scientific and humanistic characteristics of evidence-based medicine from the prospective of philosophy, so as to facilitate the extensive application of evidence based practice paradigm in other fields.
引文
1李幼平,李静,孙鑫,等.循证医学在中国的起源与发展:献给中国循证医学20周年.中国循证医学杂志,2016, 16(1):2-6.
2夏征农,主编.辞海.上海:上海辞书出版社,1999.
3魏屹东.科学与非科学及伪科学的界定.学会月刊,2002,(2):3-4.
4 Available at:https://sciencecouncil.org/about-science/ourdefinition-of-science/.
5李醒民.知识的三大部类-自然科学、社会科学和人文学科.学术界,2012, 171(8):5-33.
6 American Association for the Advancement of Science. Science for all americans, Chapterl:the nature of science, 1989. Available at:http://www.project2061.org/publications/sfaa/online/chapl.htm.
7 Humanities Council of Washington D.C. Defining the humanitiesa work in progress, 2001. Available at:http://www.wdchumanities.org/docs/defininghumanities.pdf.
8李维武.什么是人文科学.武汉大学学报(哲学社会科学版),1999,(4):49-54.
9周星,郭功星,贾雷.消费者信任缺失与重塑-基于人文精神的视角.现代管理科学,2012,(5):30-32.
10 Cecil RLF, Wyngaargen JB, Smith LH, et al. Cecil textbook of medicine(Volume 1). Washington D.C.:Saunders, 1992.
11中国社会科学院语言研究所.现代汉语词典(第6版).北京:商务印书馆,2012.
12 Munson R. Why medicine cannot be a science. J Med Philos, 1981,6(2):183-208.
13刘虹.论医学哲学范畴.医学与哲学,2007, 28(9):1-4.
14杜治政.关于医学是什么的再思考.自然辩证法研究,2008,24(6):16-22.
15李幼平,主编.循证医学(第一版).北京:高等教育出版社,2003.
16李晨,张炬倩,蔡羽嘉,等.以患者为本,探索临床干预的真实疗效-记Iain Chalmers的成长奋斗历程.中国循证医学杂志,2007,7(4):321-325.
17 Djulbegovic B, Guyatt GH, Ashcroft RE. Epistemologic inquiries in evidence-based medicine. Cancer Control, 2009, 16(2):158-168.
18 Haynes RB.循证医学倡导者希望卫生服务提供者和消费者关注什么样的证据.中国循证医学杂志,2004,4(6):361-365.
19李琰,李幼平,兰礼吉,等.循证医学的认识论探究.医学与哲学,2014, 35(4):1-4.
20吴泰相,卞兆祥,李幼平,等.临床试验原始数据共享:关于医学研究伦理的哲学命题及其对临床试验的意义.中国循证医学杂志,2018, 18(5):410-414.
21米娜瓦尔·阿不都,郝园,孔翔瑜,等,中国临床试验注册10年:现状与问题.中国循证医学杂志,2018,18(5):398-402.
22李琰,李幼平,兰礼吉.循证医学的证据特征研究及其伦理学分析.医学与哲学,2014, 35(12):39-42.
23孙福川,王明旭,主编.医学伦理学.北京:人民卫生出版社,2015.
24陈耀龙,李幼平,杜亮,等.医学研究中证据分级和推荐强度的演进.中国循证医学杂志,2008, 8(2):127-133.
25 WHO Regional Office for Europe. Patient safety. Available at:http://www.euro.who.int/en/health-topics/Health-systems/patient-safety/patient-safety.
26 Eichhorn JH. The Anesthesia Patient Safety Foundation at 25:a pioneering success in safety, 25th anniversary provokes reflection,anticipation. Anesth Analg, 2012,114(4):791-800.
27 WHO. Patient safety:rapid assessment methods for estimating hazards. Geneva:Report of WHO working group meeting, 2009.Available at:http://www.who.int/patientsafety/en.
28刘建平.中医药临床试验的方法学问题与挑战:循证医学的观点.中西医结合学报,2006, 4(1):1-6.
29 Gordon G.循证医学:过去、现状和未来(二).中国循证医学杂志,2004, 4(1):7-9.
30 Miranda H. Great medical advance:sanitation. Available at:https://www.webmd.com/a-to-z-guides/news/20070119/greatestmedical-advancement-sanitation#1.
2夏征农,主编.辞海.上海:上海辞书出版社,1999.
3魏屹东.科学与非科学及伪科学的界定.学会月刊,2002,(2):3-4.
4 Available at:https://sciencecouncil.org/about-science/ourdefinition-of-science/.
5李醒民.知识的三大部类-自然科学、社会科学和人文学科.学术界,2012, 171(8):5-33.
6 American Association for the Advancement of Science. Science for all americans, Chapterl:the nature of science, 1989. Available at:http://www.project2061.org/publications/sfaa/online/chapl.htm.
7 Humanities Council of Washington D.C. Defining the humanitiesa work in progress, 2001. Available at:http://www.wdchumanities.org/docs/defininghumanities.pdf.
8李维武.什么是人文科学.武汉大学学报(哲学社会科学版),1999,(4):49-54.
9周星,郭功星,贾雷.消费者信任缺失与重塑-基于人文精神的视角.现代管理科学,2012,(5):30-32.
10 Cecil RLF, Wyngaargen JB, Smith LH, et al. Cecil textbook of medicine(Volume 1). Washington D.C.:Saunders, 1992.
11中国社会科学院语言研究所.现代汉语词典(第6版).北京:商务印书馆,2012.
12 Munson R. Why medicine cannot be a science. J Med Philos, 1981,6(2):183-208.
13刘虹.论医学哲学范畴.医学与哲学,2007, 28(9):1-4.
14杜治政.关于医学是什么的再思考.自然辩证法研究,2008,24(6):16-22.
15李幼平,主编.循证医学(第一版).北京:高等教育出版社,2003.
16李晨,张炬倩,蔡羽嘉,等.以患者为本,探索临床干预的真实疗效-记Iain Chalmers的成长奋斗历程.中国循证医学杂志,2007,7(4):321-325.
17 Djulbegovic B, Guyatt GH, Ashcroft RE. Epistemologic inquiries in evidence-based medicine. Cancer Control, 2009, 16(2):158-168.
18 Haynes RB.循证医学倡导者希望卫生服务提供者和消费者关注什么样的证据.中国循证医学杂志,2004,4(6):361-365.
19李琰,李幼平,兰礼吉,等.循证医学的认识论探究.医学与哲学,2014, 35(4):1-4.
20吴泰相,卞兆祥,李幼平,等.临床试验原始数据共享:关于医学研究伦理的哲学命题及其对临床试验的意义.中国循证医学杂志,2018, 18(5):410-414.
21米娜瓦尔·阿不都,郝园,孔翔瑜,等,中国临床试验注册10年:现状与问题.中国循证医学杂志,2018,18(5):398-402.
22李琰,李幼平,兰礼吉.循证医学的证据特征研究及其伦理学分析.医学与哲学,2014, 35(12):39-42.
23孙福川,王明旭,主编.医学伦理学.北京:人民卫生出版社,2015.
24陈耀龙,李幼平,杜亮,等.医学研究中证据分级和推荐强度的演进.中国循证医学杂志,2008, 8(2):127-133.
25 WHO Regional Office for Europe. Patient safety. Available at:http://www.euro.who.int/en/health-topics/Health-systems/patient-safety/patient-safety.
26 Eichhorn JH. The Anesthesia Patient Safety Foundation at 25:a pioneering success in safety, 25th anniversary provokes reflection,anticipation. Anesth Analg, 2012,114(4):791-800.
27 WHO. Patient safety:rapid assessment methods for estimating hazards. Geneva:Report of WHO working group meeting, 2009.Available at:http://www.who.int/patientsafety/en.
28刘建平.中医药临床试验的方法学问题与挑战:循证医学的观点.中西医结合学报,2006, 4(1):1-6.
29 Gordon G.循证医学:过去、现状和未来(二).中国循证医学杂志,2004, 4(1):7-9.
30 Miranda H. Great medical advance:sanitation. Available at:https://www.webmd.com/a-to-z-guides/news/20070119/greatestmedical-advancement-sanitation#1.