Quantification and the Quest for Medical Certainty
J. Rosser Mathews
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Naturwissenschaften, Medizin, Informatik, Technik / Naturwissenschaften allgemein
Since its inception in World War II, the clinical trial has evolved into a standard procedure in determining therapeutic efficacy in many Western industrial democracies. Its features include a "control" group of patients that do not receive the experimental treatment, the random allocation of patients to either the experimental or control group, and the use of blind assessment so that the researchers do not know which patients are in either group. Even though it has been only within the past generation that the clinical trial has moved to the forefront of medical research, comparative statistics in a therapeutic context has a much longer history. From that history J. Rosser Matthews chooses to discuss three crucial debates: that among clinicians before the Parisian Academy of Medicine in 1837, the debate in the German physiological literature during the 1850s, and, in the early twentieth century, the debate over the bacteriologist's diagnostic technique involving the "opsonic index."
Matthews demonstrates that despite the very real differences separating clinician, physiologist, and bacteriologist, they all shared an antipathy toward the methods of the statistician. Since they viewed medical judgment as a form of "tacit knowledge," they downplayed the concerns of the medical statistician who was attempting to make medical inference into something explicit and quantitative. Only when "medical decision-making" moved from the cloistered confines of professional medical expertise into the arena of open political debate could the medical statistician (and the clinical trial) gain the upper hand.
Formal methods, Thomas Henry Huxley, Serum (blood), New drug application, Efficacy, Royal Society of Medicine, Health care, Bacteriology, Clinical research, Bruno Latour, Physical examination, Leonard Hill (physiologist), Abscissa, Clinical urine tests, Medical ethics, Medical diagnosis, Tu quoque, Epidemiology, Abortion, Council for International Organizations of Medical Sciences, Medical school, Mathematician, Gresham College, Public health, Polemic, Emergence, Mathematics, Medical writing, Medical research, First Department, Moral obligation, The Physician, Prison reform, Symptom, Medical literature, Special case, Clinician, Transmission (medicine), Applied science, Alternative medicine, Clinical Medicine, Clinical trial, Tracheotomy, Anthropometry, Proscription, Hygiene, Research institute, Vaccination, Biology, Coronary thrombosis, Scientific community, Medical statistics, Medical history, Analogy, Primary source, Objectivity (philosophy), Fact, Scientific method, Doctor–patient relationship, Statistician, Measurement, Health care in the United States, Self-image, Medical abortion, Physiology, Medical observation, Experimental data, Diagnosis, Autopsy, Lecture, Pyaemia, Specialty (medicine), Physician, Indication (medicine), National Institute for Medical Research, Reform movement, Inference, Result, British Medical Association, Modernity, Observation, Antibody, The Principles and Practice of Medicine, Experiment, Medical Research Council (United Kingdom), Lithotomy, Probability, Eugenics, Disease, Statistic, Pharmaceutical industry, Pharmacist, Quantification (science), Scientific law, Psychiatrist, Statistics, Surgery, Research program, Science, Theory