CAJ | 학술논문

循证医学建立的证据理念、标准和体系，是医学科学证据产生、评价、认可与使用的一般性规则，其运用于具体临床个案时不可避免地遭遇诸多质疑。通过对比传统经验医学证据与循证医学证据的区别，在证据的一般特征框架下讨论了循证医学的证据特征，整理了质疑循证医学的观点。争议表现在对随机对照试验的诸多伦理问题上；一般性证据如何用于个体患者；还有其更深层次的哲学追问：“真”的证据如何实现“善”的后果。最后指出，尽管创始时循证医学忽略了其科学哲学基础，但其发展和完善不能离开哲学支撑。
순증의학건립적증거이념、표준화체계，시의학과학증거산생、평개、인가여사용적일반성규칙，기운용우구체림상개안시불가피면지조우제다질의。통과대비전통경험의학증거여순증의학증거적구별，재증거적일반특정광가하토론료순증의학적증거특정，정리료질의순증의학적관점。쟁의표현재대수궤대조시험적제다윤리문제상；일반성증거여하용우개체환자；환유기경심층차적철학추문：“진”적증거여하실현“선”적후과。최후지출，진관창시시순증의학홀략료기과학철학기출，단기발전화완선불능리개철학지탱。
The ideas ,standards and system of evidence‐based medicine (EBM)are general rules though which we produce , evaluate ,accredit and use medical evidence .However ,they have been questioned when they are applied to the specific clinical cases .This paper compared the differences between the evidences in traditional experience medicine and those in EBM ,discussed the characteristics of EBM ’ s evidence . T hen , it cleared up the reasons w hich queried EBM . T hese arguments included many ethics controversies of random controlled trails (RCT ) , how to apply general evidences to individual patients ,and more profound philosophical quests on how to attain‘good’ consequence though‘real’ evidence . At last ,this paper pointed out that the development and consummate of EBM cannot exist without the sustainment of philosophy .