The book is organized so as to address in separate sections first the preparatory topics of medicine (clinical and epidemiological), science in general, and statistics (mathematical); then topics of epidemiological research proper; and, finally, topics of 'meta-epidemiological' clinical research. In those two main sections, a further grouping is based on the distraction between objects and methods of study. In this framework, the particular topics are addressed both descriptively and quasi-prescriptively, commonly with a number of explicatory annotations. This book is intended to serve as a handbook for whomever is, in whatever way, concerned with epidemiological or 'meta-epidemiological' clinical research. But besides this, it is also intended to serve as a textbook for students in introductory courses on 'epidemiological' research - to which end there is a suggested hierarchy of the concepts that might reasonably be covered.

Having last year published "Up from Clinical Epidemiology & EBM" and also "Epidemiological Research: Terms and Concepts," Miettinen now - this time with collaboration from his junior colleague I. Karp - brings out this further introduction into epidemiological research; and he is now working on an introduction into clinical research, for publication next year. It evidently is Miettinen's felt time to crystallize the basic understandings he has come to as the culmination of a half-century of concentrated effort to advance the theory of epidemiological and 'meta-epidemiological clinical' research.

In accord with its title, this book focuses on research to develop the knowledge-base for preventive medicine, which mainly is knowledge about the causal origin -etilogy, etiogenesis - of illness. It first illustrates how wanting this knowledge still is, despite much research; and it then aims to guide the reader to more productive etiogenetic research.

This book places much emphasis on the need to assure relevance by principles-guided objects design for the studies, which now remains conspicuously absent from epidemiologists' concerns. And as for methods design, this book exposes the fallacies in the still-common 'cohort' and 'case-control' studies, defines the essentials of all etiogenetic studies, and then addresses the true options for design in this framework of shared essentials.

A good deal of attention is also given to the still commonly-held, very major, twin fallacies that screening for an illness is a preventive intervention, to be studied by randomized trials, and that research on it can imply rational guidelines or recommendations regarding decisions about the screening.

While Miettinen already is regarded as 'the father of modern epidemiology, ' he now appears to have become the father also of post-modern epidemiology, where 'epidemiology' still means epidemiological research."

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.

"

The book is organized so as to address in separate sections first the preparatory topics of medicine (clinical and epidemiological), science in general, and statistics (mathematical); then topics of epidemiological research proper; and, finally, topics of 'meta-epidemiological' clinical research. In those two main sections, a further grouping is based on the distraction between objects and methods of study. In this framework, the particular topics are addressed both descriptively and quasi-prescriptively, commonly with a number of explicatory annotations. This book is intended to serve as a handbook for whomever is, in whatever way, concerned with epidemiological or 'meta-epidemiological' clinical research. But besides this, it is also intended to serve as a textbook for students in introductory courses on 'epidemiological' research - to which end there is a suggested hierarchy of the concepts that might reasonably be covered.

Having last year published "Up from Clinical Epidemiology & EBM" and also "Epidemiological Research: Terms and Concepts," Miettinen now - this time with collaboration from his junior colleague I. Karp - brings out this further introduction into epidemiological research; and he is now working on an introduction into clinical research, for publication next year. It evidently is Miettinen's felt time to crystallize the basic understandings he has come to as the culmination of a half-century of concentrated effort to advance the theory of epidemiological and 'meta-epidemiological clinical' research. In accord with its title, this book focuses on research to develop the knowledge-base for preventive medicine, which mainly is knowledge about the causal origin -etilogy, etiogenesis - of illness. It first illustrates how wanting this knowledge still is, despite much research; and it then aims to guide the reader to more productive etiogenetic research. This book places much emphasis on the need to assure relevance by principles-guided objects design for the studies, which now remains conspicuously absent from epidemiologists' concerns. And as for methods design, this book exposes the fallacies in the still-common 'cohort' and 'case-control' studies, defines the essentials of all etiogenetic studies, and then addresses the true options for design in this framework of shared essentials. A good deal of attention is also given to the still commonly-held, very major, twin fallacies that screening for an illness is a preventive intervention, to be studied by randomized trials, and that research on it can imply rational guidelines or recommendations regarding decisions about the screening. While Miettinen already is regarded as 'the father of modern epidemiology,' he now appears to have become the father also of post-modern epidemiology, where 'epidemiology' still means epidemiological research.

'Clinical epidemiology' is now widely promoted and taught as a 'basic science' of Evidence-Based Medicine, of clinical EBM to be specific. This book, however, is mostly about that which Miettinen takes to be the necessary substitute for this now-so-fashionable subject - namely, Theory of Clinical Medicine together with its subordinate Theory of Clinical Research. The leit motif in all of this is Miettinen's perception of the need, and opportunity, to bring major improvements into clinical medicine in this Information Age, now that theoretical progress has made feasible the development of practice-guiding Expert Systems for it. Parts of this text constitute essential reading for whoever is expected, or otherwise inclined, to study - or teach - 'clinical epidemiology,' and the same is true of those who set policy for the education of future clinicians; but practically all of it is essential reading for future - and current - academics in the various disciplines of clinical medicine. After all, the text is the result of a concentrated effort, over a half-century no less, to really understand both clinical and community medicine and the research to advance the knowledge-base of these. Research epidemiologists, too, will find this text interesting and instructive.

This book exposes, and fills, a notable void in the educational content generally covered in modern schools of medicine. It provides an introduction to the field at large in terms of content that is relevant for each of the specialties and subspecialties of medicine; and to this end, it addresses the modern counterpart of the Hippocratic philosophy that was at the root of the genesis of modern medicine. The much-needed but still-missing introductory content for the interdisciplinary 'medical common,' provided in this book, addresses mainly the most elementary concepts and principles of medicine. Those concepts flow, hierarchically, from the essence of (health and) ill-health/illness for one and that of medicine for another, both of these critically formulated; and those principles are dictates of logic and ethics, both specific to medicine. While a modern physician is expected to be competent as a scholar in his/her particular discipline of medicine, study of this book is essential for the development of that competence -- for learning, for example, to make a tenable distinction between scientific medicine and medical science, and between knowledge-based medicine (scientific and other) and its opinion-based substitutes ('evidence-based' and other). "To me it is astonishing and to medicine actually shameful that it has taken up to year 2015 before there is a work in which the essence of medicine is described and discussed." -- J. Steurer, University of Zurich "[In this book], Miettinen beautifully elucidates the concepts and principles of knowledge-based diagnosis, and prognosis, within medicine. Now, after six decades of keen observation and study, and critical reflection on medicine and medical research, Miettinen, in this book, shares the fundamental understandings he has reached; ..." -- T. J. VanderWeele, Harvard University "The aim of this book ... is admirable. The composition of the book -- from the key concepts to logical and ethical principles -- is very clear and systematic. I am convinced that this kind of book is needed." -- I. Niiniluoto, University of Helsinki

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 diagnoses by 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.

'Clinical epidemiology' is now widely promoted and taught as a 'basic science' of Evidence-Based Medicine, of clinical EBM to be specific. This book, however, is mostly about that which Miettinen takes to be the necessary substitute for this now-so-fashionable subject - namely, Theory of Clinical Medicine together with its subordinate Theory of Clinical Research. The leit motif in all of this is Miettinen's perception of the need, and opportunity, to bring major improvements into clinical medicine in this Information Age, now that theoretical progress has made feasible the development of practice-guiding Expert Systems for it. Parts of this text constitute essential reading for whoever is expected, or otherwise inclined, to study - or teach - 'clinical epidemiology,' and the same is true of those who set policy for the education of future clinicians; but practically all of it is essential reading for future - and current - academics in the various disciplines of clinical medicine. After all, the text is the result of a concentrated effort, over a half-century no less, to really understand both clinical and community medicine and the research to advance the knowledge-base of these. Research epidemiologists, too, will find this text interesting and instructive.