Practice Of Systematic Review In EBM And Its Analysis In View Of Value Philosophy

As a great change in medical conception, theories and behaviors, evidence-based medicine (EBM) has been the focus of medical research at present. This change not only has a deep impression on the development of medical sciences but also permeates all the horizons of economy, culture and society. In the developed countries, EBM has been a sophisticated medical behavior mode which had been accepted extensively. The number of researches on EBM is increasing daily. In China, the researches on EBM were performed later, but they had became the hot points in medical researches sooner. Since the Chinese EBM center was established in the Hua Xi Medical School, Si Chuang University and became a member of the Cochrane Collaboration, the visual field of the EBM researchers in China had merged with the frontier of EBM researches of the world. The development of researches of EBM in China has been a new growing point of the researches in the world.As EBM developing, the theoretic disputes and practical problems appeared at the same time. Owing to these disputes and problems, people have no foundation except for the limited methods in statistics and epidemiology when they perform EBM mode. Someone even purposes that EBM would become a methodology. After practicing on EBM for many years, practicers, especially the EBM researchers in other countries, have to discard the mask of methodology and search for the essence of EBM. They begin to employ the methods of philosophy and sociology to explore EBM.The present researches on EBM are either practical ones or theoretic ones. However, the existing disputes and problems include both practical ones and theoretic ones, and lie in the fields of both medical sciences and philosophy. Obviously, such complicated problems would not be solved by a single method whether the method is medical one or philosophical one.According to Marxism, the philosophic route to recognize and solve problems is"practice-theory-practice","sensibility-rationality-sensibility"and"speciality-generality-speciality". As a result, this paper followed the above route by experiencing the procedure of a systematic review (SR), analyzing the value orientations in the medical information activity of the SR by means of value philosophy, refining and summarizing"Evidence-based Value"in EBM. This paper attached importance to expounding the value relation, primary philosophy and social conception foundation of the"Evidence-based Value". This paper summarized the essence of such value, emphasized that EBM is the"Evidence-based Value"and its epitaxy, and advocated assimilating it as Chinese native value. Combining the practical methods with theoretic ones, this paper employed multi-methods such as those of medical informatics, medical philosophy and social medicine to expound and solve the problems in EBM. Research that used methods similar as those in this paper has not been reported.This paper chose the clinical problem——the drug therapy of idiopathic pulmonary fibrosis——as the subject of the SR which was named as"interferon for idiopathic pulmonary fibrosis, a systematic review". In this SR, PubMed, EMBASE and Cochrane Library were searched (till Nov, 2006), 122 papers were founded (one of them was ongoing and six of them were conference literatures), and authors were contacted by e-mail to collect unpublished and gray literatures. Two doctors in the No.1 hospital were applied to identify and include studies and the full texts were search in information office of Chinese Academy of medical sciences, the medical library of Jilin University, the library of No.1 hospital of Jilin Universtiy, the library of Jilin Province. Three studies were included in this SR and were distributed into two subgroups, namely the group of"1yr, placebo control"and the group of"2yr, colchicines control". In this SR, Meta-analysis and heterogeneity analysis were performed, the 95% CI of RR concentrating on the outcome of death was calculated, adverse effects of the drug were reviewed, and the results were discussed and interpreted cautiously.The second part of this paper is the analysis of EBM in view of value philosophy to analyze and expound the value foundation of EBM. By rectifying and analyzing the sensible data in process of the SR, the author summarized the value orientations in the information activity of SR: attaching importance to obtaining universal information resources, treating individual information in an add-weight way, discretion in interpreting results and updating of time-limited information in the medical information activities. Furthermore, the author refined the conception foundation of EBM——"Evidence-based Value"and reached conclusions as followings:1. The value relations foundation that creates"Evidence-based Value"are the relations of doctor-evidence, doctor-patient, patient-evidence in evidence-using process and the relations of researcher-evidence, researcher-doctor, doctor-evidence in evidence-creating process. These relations and benefits of all the above groups are connected by evidence.2. The primary philosophy foundations of"Evidence-based Value"are the thought of seeking truth from facts and unifying practicing process and recognizing process. 3. The social conception foundations of"Evidence-based Value"are the social conception of worshipping individual benefit as foundation, constructing fair and harmonious medical activity horizon.4. The connotation of"Evidence-based Value"is to regard scientific cognition, practical and experimental knowledge, developing knowledge, fairly-distributed social resource, and balanced benefit relation as values.5. In assimilating"Evidence-based Value"as Chinese native value, it is worthy to be cautious of following: do not regard"absolutely uniform"as value, cultivate the conception soil of EBM, combine the EBM practice with medical ethics, go with the tide and propel the construction of Clinical Trial Register.This paper attempted to employ philosophical method to explore medical problems following philosophical route. However, the content and achievements of this paper were not limited in thinking about medical problems in view of philosophy. At each level, achievements were obtained: the SR at clinical medicine level, the value orientations at medical informatics level, the"Evidence-based Value"at philosophy level. However, limited by time, fund, labor and individual ability, the quality of the SR in this paper was low, analysis was only about the evidence-creating process, and"Evidence-based Value"had not been checked by practices. All the above is regret in this paper and waits for the following researches to explore and clarify.