Scientific medicine in Miettinen s conception of it is very
different from the two ideas about it that come to eminence in the
20th century. To him, medicine is scientific to the extent that it
has a rational theoretical framework and a knowledge-base from
medical science. He delineates the nature of that theoretical
framework and of the research to develop the requisite knowledge
for application in such a framework. The knowledge ultimately
needed is about diagnostic, etiognostic, and prognostic
probabilities, and it necessarily is to be codified in the form of
probability functions, embedded in practice-guiding expert
systems.
In these terms, today s medicine still is mostly pre-scientific,
and major innovations are needed within and around medicine for
healthcare to get to be in tune with reasonable expectations about
it in this Information Age. Thus, while the leading cause of
litigation for medical malpractice in the U.S. is failure to
expeditiously and correctly diagnose the probability of myocardial
infarction in a hospital s emergency room, this book shows that a
typical modern textbook of cardiology, just as one of medicine at
large, imparts no knowledge about the diagnostic probabilities
needed in this, and that the prevailing type of diagnostic research
will not produce the requisite knowledge. If the diagnostic
pursuits in an ER would be guided by an emergency-room diagnostic
expert system, this would guarantee expert diagnosesby all ER
doctors.
Academic leaders of medicine and medical researchers concerned
to advance the knowledge-base of medicine will find a wealth of
stimulus for thinking about the deficiencies of the prevailing
knowledge culture in and surrounding medicine, and about the
directions of the needed progress toward genuinely scientific
medicine.
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