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循证医学 is a scientific way making clinical decision, based on the best available scientific data at the time. It dose not require the scientific research conducted perfectly fit for the particular clinical situations.
Hypothetically, a reasonably well designed and conducted clinical investigation in US or other country reported a drug showiing fetal toxicity in a group of white or AA persons, but no study has been performed on the fetal toxicity of this drug in China or asia. With 循证医学, Chinese physicians should inform their patients of the study result done in US, showing fetal toxicity. The physician shall advice the patient to be cautious when using and even not to use this drug completely, depending on the data.
Thus, 循证医学 dose not require additional financial and/or research investment of local people and goverments, but the physician being update with most current knowledges of medical science regarding the specific topics/ issues at hand, as well as incooperating this kind of the evidence-based medical diagnosis and intervention in training medical professioners and in their clinical practice. That is part of the reasons for maintaining regular continue medical education (CME) for each physician in US.
一位最近在中国参加一次中美医学专业会议的美国医师告诉我,会上美国医师介绍本学科临床进展时,来自美国的同行总是能不约而同地引用相同的临床试验 (Clinical Trials) 数据,津津有味的讨论。 同时与会的国内医师,介绍本学科临床进展时, 各说各的,以本地小样本的资料为多,很少同行公认的大组临床试验的资料。因此即使在国人同行之间,常常讨论的基点不一。
本人多年前在国内搞临床时, 同行就经常有这类话题,诸如“这种治疗是北京派的做法,上海派的做法不同”,“广州的做法又不同”。在咱福建,临床医师使用的某种特定的疗法常与他/她在哪个地方进修有点关系。年轻的又免不了受带教的上级影响。师带徒。八路英雄,各显神通。互不买账。
中国临床医务工作人员,在循证医学方面任重道远。跟财力有关,毕竟进行大组、严格控制的、前瞻性分组临床试验, 周期长,耗资大。另一方面,人的意识也很重要。