Toward a general theory of indifference to research-based evidence.
Toward a general theory of indifference to research-based evidence.
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DOI：
10.1258/135581907781543094
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发表时间：
2007-07-01
影响因子：
2.4
通讯作者：
Lewis, Steven
中科院分区：
文献类型：
--
作者：
Lewis, Steven
循证医学（EBM）和循证决策（EBDM）旨在彻底改变医疗保健和卫生政策。到目前为止他们还没有。大量研究表明，医疗保健中的错误普遍存在，实践中存在广泛且不合理的变化，以及临床实践指南等决策辅助工具的影响微乎其微。本文试图解释为什么 EBM 和 EBDM 的抱负在很大程度上仍未实现。它提出了 10 个命题，共同构成了对基于研究的证据漠不关心的一般理论。其中一些命题是概念性的（例如，对随机试验的认知阻力），一些是经验性的（例如，工业对科学腐败的影响），一些是认知性的（例如，人类问题是整体性的，而科学通常是支离破碎且无叙述性的），还有一些是规范性的（例如，主要目标不是遵守方法，而是做出更好的决策，获得更好的结果，无论其起源如何）。 EBM 和 EBDM 做得太过分了，因此它们的失败是不可避免的。然而，随着在多个方面采取纠正行动，基于研究的证据可以而且应该更具影响力。第一步是将 EBM 和 EBDM 重新视为思维习惯而不是工具箱，并认识到知识社会学与其技术内容同样重要。
Evidence-based medicine (EBM) and evidence-based decision-making (EBDM) were intended to revolutionize health care and health policy. Thus far they have not. A great deal of research has demonstrated the persistent ubiquity of error in health care, wide and unjustifiable variations in practice and the minimal impact of decision aids such as clinical practice guidelines. This paper attempts to explain why EBM and EBDM have remained largely unrealized ambitions. It advances 10 propositions that together constitute a general theory of indifference to research-based evidence. Some of these propositions are conceptual (e.g. the epistemic resistance to the randomized trial), some are empirical (e.g. the impact of the corruption of science by industry), some are cognitive (e.g. human problems are holistic while science is typically fragmented and narrative free) and some are normative (e.g. the primary goal is not adherence to methods, but to make better decisions with better outcomes, irrespective of their origins). EBM and EBDM over-reached, and their failure was, as a consequence, inevitable. However, with corrective action on a number of fronts, research-based evidence can and should be more influential. The first step is to reconceive EBM and EBDM as habits of mind rather than a toolbox and to recognize that the sociology of knowledge is as important as its technical content.