Ciulla Michele M
Laboratory of Clinical Informatics and Cardiovascular Imaging, University of Milan, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Front Med (Lausanne). 2021 Jun 16;8:510421. doi: 10.3389/fmed.2021.510421. eCollection 2021.
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 approach is supported, namely, a relationship with the individual patient.
医学实践越来越受到统计数学模型的指导,这些模型无疑是有价值的工具,但也只是现实的部分呈现。事实上,鉴于统计数据或多或少可能存在不足,模型仍然是研究者的主观解释,并且还受到其运行所处历史背景的影响。基于这一观点,我将进行简短的历史回顾,追溯概率医学的出现,这是一个漫长的过程,其开端应追溯到对疾病复杂性的发现。通过支持这一演变属于科学领域,人们也承认其潜在模型可能是不完美或易错的,因此,如同任何科学产物一样是可被质疑的。的确,重拾这些概念似乎并非易事,尤其是在如今临床决策依赖于实践指南的情况下,这些指南是多种观点(包括对疾病的概率方法)汇总而成的混合产物。最后,在精准医学出现之前,通过将指南的使用限制在最初的咨询背景下,支持一种方法,即与个体患者建立关系。