Grossi Enzo
Medical Department, Bracco SpA Milan, Italy.
BMC Cardiovasc Disord. 2005 Sep 27;5:31. doi: 10.1186/1471-2261-5-31.
The concept of risk has pervaded medical literature in the last decades and has become a familiar topic, and the concept of probability, linked to binary logic approach, is commonly applied in epidemiology and clinical medicine. The application of probability theory to groups of individuals is quite straightforward but can pose communication challenges at individual level. Few articles by the way have tried to focus the concept of "risk" at the individual subject level rather than at population level.
The author has reviewed the conceptual framework which has led to the use of probability theory in the medical field in a time when the principal causes of death were represented by acute disease often of infective origin. In the present scenario, in which chronic degenerative disease dominate and there are smooth transitions between health and disease the use of fuzzy logic rather than binary logic would be more appropriate. The use of fuzzy logic in which more than two possible truth-value assignments are allowed overcomes the trap of probability theory when dealing with uncertain outcomes, thereby making the meaning of a certain prognostic statement easier to understand by the patient.
At individual subject level the recourse to the term plausibility, related to fuzzy logic, would help the physician to communicate to the patient more efficiently in comparison with the term probability, related to binary logic. This would represent an evident advantage for the transfer of medical evidences to individual subjects.
在过去几十年中，风险概念已渗透到医学文献中并成为一个常见话题，与二元逻辑方法相关的概率概念在流行病学和临床医学中普遍应用。将概率论应用于个体群体相当直接，但在个体层面可能会带来沟通挑战。顺便说一句，很少有文章试图将“风险”概念聚焦于个体层面而非群体层面。
作者回顾了在主要死因通常为感染性急性疾病的时期，导致概率论在医学领域应用的概念框架。在目前慢性退行性疾病占主导且健康与疾病之间存在平稳过渡的情况下，使用模糊逻辑而非二元逻辑会更合适。在模糊逻辑中允许有超过两种可能的真值赋值，克服了概率论在处理不确定结果时的陷阱，从而使患者更容易理解特定预后声明的含义。
在个体层面，使用与模糊逻辑相关的似真性一词，与与二元逻辑相关的概率一词相比，将有助于医生更有效地与患者沟通。这对于将医学证据传递给个体将是一个明显的优势。
