Scientific medicine in Miettinen's conception of it is very different
from the two ideas about it that come to eminence in the 20th
century. To him, medicine is scientific to the extent that it has a
rational theoretical framework and a knowledge-base from medical
science. He delineates the nature of that theoretical framework and of
the research to develop the requisite knowledge for application in such
a framework. The knowledge ultimately needed is about diagnostic,
etiognostic, and prognostic probabilities, and it necessarily is to be
codified in the form of probability functions, embedded in
practice-guiding expert systems.
In these terms, today's medicine still is mostly pre-scientific, and
major innovations are needed within and around medicine for healthcare
to get to be in tune with reasonable expectations about it in this
Information Age. Thus, while the leading cause of litigation for medical
malpractice in the U.S. is failure to expeditiously and correctly
diagnose the probability of myocardial infarction in a hospital's
emergency room, this book shows that a typical modern textbook of
cardiology, just as one of medicine at large, imparts no knowledge about
the diagnostic probabilities needed in this, and that the prevailing
type of diagnostic research will not produce the requisite knowledge. If
the diagnostic pursuits in an ER would be guided by an emergency-room
diagnostic expert system, this would guarantee expert diagnoses by all
ER doctors.
Academic leaders of medicine and medical researchers concerned to
advance the knowledge-base of medicine will find a wealth of stimulus
for thinking about the deficiencies of the prevailing knowledge culture
in and surrounding medicine, and about the directions of the needed
progress toward genuinely scientific medicine.
