 《三思科学》电子杂志
2003年2/3月份合刊
总第19期
2003年3月31日
目 录
封面
封面故事
[碧声]紫花地丁
新闻
[春上莱茵早]CEBIT:今年手机唱主角
[三思新闻编辑]2~3月份科学新闻
├ 德国科学家发明出“神经芯片”
├ 伊油田大火扰乱候鸟迁徙路线
├ 战争带来的心灵创伤将长久难愈
├ 全球最快的PC亮相CeBIT
├ 世界第一个修补大脑的芯片
├ 三十万年前的人类脚印
├ 再见，先驱者10号
├ 一种艾滋病疫苗进入第三期试验
├ 鱼脑中发现普里昂蛋白
├ 化学元素大家庭的新成员：Ds
├ 火扑飞蛾
├ 克隆羊多利“安乐”辞世
├ 宇宙“婴儿期”的最精细照片
├ 没有最黑，只有更黑
├ 哥伦比亚号航天飞机失事
├ 用四肢滑翔
└ 柏林国际绿色周散记
循证医学专题
[江华]循证医学：临床医学观的科学化
[皮特·朗洪]世界为什么需要循证医学
[苡菥莼]什么是系统评价
[江华、蒋朱明]核酸的治疗或预防功能
的评价
求知
[碧声]一只绵羊的一生
[碧声]再见，多利
[陶世龙]走出认识地球的误区
(二)凡尔纳一次失败的幻想
(三)大气圈--地球真正的外壳
[逍遥]终极巫术--疯牛病小传(五)
译述
[C.Macilwain]面对粮食
[G.Brumfiel]更换航天飞机:飞行与祈祷
[M.Szalavitz]爱是毒品
[M.Paetsch]没有表面:黑洞真的是洞
博物
[佳肴]甲龙
[碧声]另类星爆
观点
[赵南元]科技伦理和责任分析
历史
[高山]《量子》历史之旅
(五)回到经典、(六)多世界
辩伪
[方舟子]人参与西洋参:历史与现实,
神话与事实
[方舟子]转基因作物恐慌与真相
[W.Williams]伪科学词典(二):
复活节岛、《命运杂志》、盖娅假说
幽默
[桔梗]《科学地球人》: 4的死期
版权声明·订阅与投稿须知
三思科学杂志社
本期责编 碧 声
封面摄影 刘华杰
三思科学网站
©2003,All Rights Reserved.
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世界为什么需要循证医学
Why the World Need Evidence-Based Medicine
 皮特·朗洪
本刊特稿，Peter Langhorne, Ph.D.,FRCP著，江华译
When you attend your doctor you expect that they will use their knowledge and experience to do the right thing to improve your health. But how does your doctor know what is the right thing to do? Traditionally, doctors have been trained in a system where teachers use their experience and the collected experience of others (written down in books) to pass on medical knowledge which the doctor uses in their working life. However this process of collective experience is subject to limitations.
当你去看医生时，你期待的是他们运用知识和经验做出正确决策，从而改善你的健康状况。但你的医生又如何而知他们所做的乃是正确的呢？传统上，医生们在其职业生涯中应用的知识主要源于他们在医学教育系统中所接受的训练，这个系统中，老师们所传授的知识一部分来自于其自身的经验，另一部分则源于前人经验的总结（通过书本）。然而，这一经验收集的过程却有其局限性。
Firstly personal experience can be very misleading. Doctors tend to remember the particularly good or bad events from their experience while they may never witness some rare (but important) conditions. A good medical example of this is the ‘prevention paradox’ where an individual doctor who provides a treatment to prevent disease (for example blood pressure lowering tablets to prevent heart attacks) will usually not to see those individuals who have benefited from the tablets and continue to be in good health. However they will be asked to see those in whom the tablets fail (and have a heart attack) or those who suffer side effects of the tablets. For the individual doctor the preventive treatments often appear less effective than they actually are. Secondly it is now recognised that good clinical research methods can provide a much more reliable indication of whether a treatment does or does not work.
首先，个人的经验很可能是带有误导性的。医生们通常对那些他们经验中特别好或者坏的事例印象深刻，但与此同时，对另外一些虽然不常发生却很重要的情况，却可能从来没机会碰到。所谓“预防性治疗的悖论”的情况即是对这种看法的一个很好说明。这种情况是指，医生为了预防疾病发生给患者提供某种治疗（比如为了预防心肌梗死给患者服用降压药），而作为个体的患者，其从药物中的获益或者因治疗而取得的生存状况改善却常常是难以为医生所看到的（当药物预防有效时，多数患者的健康状况获得改善，因之去医院的人数会大为减少，所以对个别大夫而言他/她既无从知晓患者用药以后的景况改善，也自然就不会对药物的疗效有强烈的正面感受——译者注）。另一方面，医生们从一开始就被要求对那些药物治疗失败（我们的例子中即发生心肌梗死）或有不良反应出现的患者加以关注。所以，在作为个人的医生看来，预防性治疗的所表现出的效果常常比其真实有效性要差。其次，目前我们已经认识到，在确定某种治疗是否有效的问题上，好的临床研究方法（较之个人经验）能提供更为可靠的指导。
The principle of evidence-based medicine is that doctors and healthcare workers should use their knowledge and experience together with the most up-to-date reliable research evidence to guide their decisions. This process requires that the doctor must be able to find relevant research evidence and be confident that it is reliable (ie likely to be true). Therefore the doctor who uses an evidence-based medicine approach will regularly consult databases of research evidence to help them make decisions about healthcare. This has two major advantages. Firstly, their decisions will reflect up-to-date evidence. Secondly they are participating in a continuous learning process and are constantly updating their knowledge. Until recently there were no useful sources of research evidence which a busy doctor or healthcare worker could use to inform their decisions. Fortunately this is now changing with electronic published locations such as the Cochrane Library and Best Evidence. These publications provide the busy doctor with high quality reliable information to help answer their questions.
循证医学的要义在于，医生和医务工作者应当将他们的个人知识和经验与最新的可靠研究证据相结合，并以之指导他们的临床决策。这一过程要求医生必须找到相关的研究证据并能够确定其可靠性（真实性）。所以，那些愿意实践循证医学的医生们将会经常性的查询收录有研究证据的数据库，并用找到的证据来帮助他们做出卫生决策。他们这样做有两大好处。其一，他们的决策将反映最新的研究证据。其二，他们因此而参与进一个持续性的学习过程并从而不断更新了他们的知识。然而，直到不久以前，我们都还缺乏某种可以为繁忙的临床医生提供帮助的研究证据资源。幸运的是，现在随着Cochrane图书馆和Best evidence(最佳证据)之类电子出版物的出现，这种情况得到了改变。对于忙碌的医生们，这些出版物使他们在解答问题的过程中能够获得高质量可靠信息的帮助。
The principle of evidence-based medicine can also be used in decisions taken about populations of people. For instance in many European and North American countries, clinical practice guidelines are now produced which advise on the best course of treatment for particular common conditions. The best available research evidence heavily underpins these guidelines.
循证医学的原理同样可以用于人群健康决策。例如，目前在许多欧洲和北美国家，临床实践指南已被用于为治疗具有某些共通情况的患者提供最佳临床路径。在这些指南背后起重要支撑作用的，正是那些具有可用性的最佳研究证据。
In summary evidence-based medicine reflects a rational approach to medical practice which judiciously uses the best available research evidence together with appropriate experience and expertise. It offers the best chance of identifying and using treatments, which are beneficial and provides offers hope for improving healthcare across the world.
总结起来，循证医学所反映的是医疗实践中的一种理性道路，即将可以获得的最佳研究证据、适宜的个人经验以及专业知识加以完美结合的方式。它提供了最好的机会筛选并使用卓有成效的治疗措施，为改善全球卫生事业带来了新希望。
作者简介：Peter Langhorne，医学博士，教授，格拉斯哥大学（苏格兰，英国）皇家医院老年病科医师，国际Cochrane协作网现任执行主席，本文为作者应三思科学杂志社所邀而作。
中国循证医学中心
国际Cochrane协作网
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