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April 12, 2018

Formal Idiographic Inference in Medicine

Author Affiliations
  • 1Departments of Biomedical Engineering, Neuroscience and Otolaryngology, Washington University in St Louis, St Louis, Missouri
JAMA Otolaryngol Head Neck Surg. Published online April 12, 2018. doi:10.1001/jamaoto.2018.0254

Fifty years ago, Alvin Feinstein published his seminal book Clinical Judgment1 in which he argued that medicine needs reliable clinical data, a sound taxonomy of disease, and attention to the nature of clinical reasoning. The years following saw the establishment of modern evidence-based medicine (EBM), whereby the best medical decisions about a current patient are made by applying rigorously established outcomes of previous patients.2 The key instrument in both of these perspectives is a taxonomy of disease in which similarities among patient conditions are reflected in patient assignment to similar disease classes.3 Courses of disease in previous patients with a particular diagnosis then serve as predictions for the disease course of a current patient with the same diagnosis. Interpatient variability within a disease class is unaccounted for with this approach and is not formally exploited for treatment decisions.

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