Abstract
The origins of the treatment of uncertainty in clinical medicine – Part 2: the emergence of probability theory and its limitations
Highlights
[I]t is a very certain truth that, when it is not in our power to discern the truest opinions, we ought to follow the most probable.[1]
A critical turning point in the quest for certainty in clinical medicine was reached during the Renaissance: a recognition of the role of quantitative measurement
The pivotal figure here is the Italian physician Santorio Santorio (1561–1636). After studies in both medicine and mathematics at the University of Padua, Santorio began a life-long quest to bring more certainty to diagnosis and treatment. He noted that while Galen accepted that effective treatment required knowledge of both the type of disease
Summary
[I]t is a very certain truth that, when it is not in our power to discern the truest opinions, we ought to follow the most probable.[1]. In classical times, such reasoning was essentially restricted to ‘balance of probability’ arguments based on simple comparisons of proportions.[2] As such, it failed to deal with the full consequences of uncertainty in decision-making. These only became apparent after the emergence of the mathematical theory of probability in the mid-17th century. This allowed the formal treatment of issues which had long been recognised in qualitative terms, such as the role of sample size in determining the reliability of ‘balance of probability’ arguments. In the second part of this history, I examine how the theory of probability, initially seen by some as a panacea for the treatment of uncertainty in medicine, quickly sparked bitter disputes about its implications and relevance which continue to this day
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