Good intentions and received wisdom are not good enough: the need for controlled trials in public health
Good intentions and received wisdom are not good enough: the need for controlled trials in public health
复制标题
DOI：
10.1136/jech.2010.124198
复制
发表时间：
2011-07-01
影响因子：
6.3
通讯作者：
Macintyre, Sally
中科院分区：
文献类型：
--
作者：
Macintyre, Sally
在20世纪70年代，Archie科克伦指出，许多医疗程序和组织形式缺乏有效性和效率的证据，并主张改进评估方法，从临床意见和观察转向随机对照试验（RCT）。他的论点逐渐被医学界接受，但政策制定者和研究人员对将其应用于社会和公共卫生干预措施存在相当大的阻力。本文认为，反对RCT在公共卫生往往是基于医疗保健和社区环境之间的错误区分，有时对RCT的原则在医疗保健的误解。它表明，就像在医学领域一样，良好的意愿和公认的智慧并不足以成为制定公共政策和分配公共资金用于社会或健康改善的基础。
In the 1970s Archie Cochrane noted that many healthcare procedures and forms of organisation lacked evidence of effectiveness and efficiency, and argued for improved methods of evaluation, moving from clinical opinion and observation to randomised controlled trials (RCTs). His arguments gradually became accepted in medicine, but there has been considerable resistance among policymakers and researchers to their application to social and public health interventions. This essay argues that opposition to RCTs in public health is often based on a false distinction between healthcare and community settings, and sometimes on a misunderstanding of the principles of RCTs in health care. It suggests that just as in medicine, good intentions and received wisdom are not a sufficient basis for making public policy and allocating public funds for social or health improvement.