我们需要什么研究来支持将结合医学运用于临床的决策?--效益比较研究可以填补其间的沟壑吗?

Which Research Is Needed to Support Clinical Decision-Making on Integrative Medicine?——Can Comparative Effectiveness Research Close the Gap?

在补充和结合医学临床研究中,专家和科研工作者往往片面地追求研究纲领而没有充分考虑到最终服务对象,即患者的需求。因此,以往大多数的临床研究都集中在评价治疗措施的效力,却缺乏关于其临床效果的研究数据。效益比较研究(comparative effectivenesresearch,CER)旨在通过提供对可能的最佳治疗方案利弊的比较证据,使决策者能明智选择最佳治疗方案。这种证据,较之传统意义上的RCT研究证据更普遍,更适用于对实际医疗方案的决策。重视CER将为临床循证医学的发展及政策制定提供支持。诚然,在补充和结合医学的大多数领域中,CER的数据还很匮乏,针灸研究已为CER提供了一定的证据。笔者将重点介绍CER,并对将来的研究方向提供建议。

In clinical research on complementary and integrative medicine, experts and scientists have often pursued a research agenda in spite of an incomplete understanding of the needs of end users. Consequently, the majority of previous clinical trials have mainly assessed the efficacy of interventions. Scant data is available on their effectiveness. Comparative effectiveness research （CER） promises to support decision makers by generating evidence that compares the benefits and harms of best care op- tions. This evidence, more generalizable than evidence generated by traditional randomized clinical trials （ RCTs）, is better suited to inform real-world care decisions. An emphasis on CER supports the develop- ment of the evidence base for clinical and policy decision-making. Whereas in most areas of complemen- tary and integrative medicine data on CER is scarce, available acupuncture research already contributes to CER evidence. This paper will introduce CER and make suggestions for future research.