Abstract

Medical practice is increasingly coming under the guidance of statistical-mathematical models that are, undoubtedly, valuable tools but are also only a partial representation of reality. Indeed, given that statistics may be more or less adequate, a model is still a subjective interpretation of the researcher and is also influenced by the historical context in which it operates. From this opinion, I will provide a short historical excursus that retraces the advent of probabilistic medicine as a long process that has a beginning that should be sought in the discovery of the complexity of disease. By supporting the belonging of this evolution to the scientific domain it is also acknowledged that the underlying model can be imperfect or fallible and, therefore, confutable as any product of science. Indeed, it seems non-trivial here to recover these concepts, especially today where clinical decisions are entrusted to practical guidelines, which are a hybrid product resulting from the aggregation of multiple perspectives, including the probabilistic approach, to disease. Finally, before the advent of precision medicine, by limiting the use of guidelines to the original consultative context, an aged approach is supported, namely, a relationship with the individual patient.

Highlights

  • The aim of this paper is to present in a historical perspective the process that led to the affirmation of the mathematical-statistical models in medicine as a surrogate system for making clinical decisions in order to bring it back to its original theoretical and rebuttable domain

  • To identify the causes of injury and/or illness is essential for the progress of knowledge and to prevent the progress of disease and/or to develop appropriate care; the simplified causative approach, wellsummarized in Koch’s Postulates, is no longer appropriate [1]

  • Formulated to identify the pathogen responsible for a specific disease, the postulates contributed to the spread of an etiological approach based on a mono-factorial cause-effect relationship that has been replaced, since the Framingham Heart Study [2], in favor of a multifactorial one based on the concept of risk factors

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Summary

Introduction

The aim of this paper is to present in a historical perspective the process that led to the affirmation of the mathematical-statistical models in medicine as a surrogate system for making clinical decisions in order to bring it back to its original theoretical and rebuttable domain.

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