근거중심 의학의 사상-의학철학의 입장에서-

Abstract

Through the whole history of medicine　 there runs a long struggle between two principal tendencies-empiricism and rationalism　 The empirical trend lays its emphasis on “experience” for the cure of the sick　 The rationalistic trend lays its main emphasis on “mechanism” for the causes of diseases The term “evidence-based medicine(EBM)”　 defined as “the conscious　 explicit and judicious use of the best current evidence in making decisions about the individual patients”　 was introduced about ten years ago　 The proponents has been described EBM as a “paradigm shift” that will change medical practice in the years ahead　 But there has been considerable debate about the value of EBM　 The modern medicine　 following philosophy of modern science such as the ‘realism controlled by empiricism’　 has developed biomedical model　 But the EBM wrapped with clinical epidemiology and statistics　 represents response of empiricism to the rationalism(realism)　 The roots of EBM extend back at least as far as the Paris clinical school　 and the work of Pierre Louis in Paris in the early 19th century　 Is EBM a paradigm shift? To answer this question　 We have to specify the alternative with which we are comparing EBM　 The alternative to EBM is the basic science approach　 studying the pathophysiolological mechanism of the body　 But EBM is so clearly intertwined with and complementary to the basic science that it would make little sense to see EBM as a paradigm shift away from basic science　 In a sense　 evidence-based medicine shows only methodological contribution aimed at improving the gathering and sorting of the best information published by biomedical scientists and clinical epidemiologists for use in clinical practice　 Although EBM and the traditional medicine embody different approaches　 this does not mean that they are competitors　 In fact　 the two approach need each; neither can stand alone for the development of clinical practice