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pp 1–8 | Cite as

What’s Going to Happen to Me? Prognosis in the Face of Uncertainty

  • Daniele ChiffiEmail author
  • Mattia Andreoletti
Article

Abstract

Reasoning in medicine requires the critical use of a clinical methodology whose validity must be evaluated as well as its limits. In the last decade, an increasing amount of evidence has shown severe limitations and flaws in the conduct of prognostic studies. The main reason behind this fact is that prognostic judgments are at high risk of error. In this paper we investigate the pragmatic and illocutionary aspects of different forms of linguistic acts and judgments involved in clinical practice. More specifically, we analyze the role of (fundamental) uncertainty with regard to ‘particular’ clinical judgments and its relation with ‘general’ evidence. Focusing on how prognostic judgments are formulated and justified, our main purpose is to highlight the explication, the structure and the limits of prognosis from a linguistic and epistemological perspective.

Keywords

Prognosis Uncertainty Evidence Illocutionary acts Clinical reasoning Philosophy of medicine 

Notes

Acknowledgements

We thank Pierdaniele Giaretta, Fabrizio Macagno and Carlo Martini, as well as two anonymous referees for their suggestions. The work of Daniele Chiffi was supported by the Project PTDC/MHC-FIL/0521/2014 of the Portuguese Fundação para a Ciência e a Tecnologia and by the “Dipartimento di Eccellenza” project “Fragilità Territoriali” (MIUR 2018-2022). The work of Mattia Andreoletti was funded by ERC Starting Investigator Grant No. 640638.

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. Ales KL, Charlson ME (1987) In search of the true inception cohort. J Chronic Dis 40(9):881–885CrossRefGoogle Scholar
  2. Altman DG, Lausen B, Sauerbrei W, Schumacher M (1994) Dangers of using “optimal” cutpoints in the evaluation of prognostic factors. JNCI J Natl Cancer Inst 86(11):829–835CrossRefGoogle Scholar
  3. Andreoletti M (2018) More than one way to measure? A casuistic approach to cancer clinical trials. Perspect Biol Med 61(2):174–190CrossRefGoogle Scholar
  4. Andreoletti M, Teira D (2016) Statistical evidence and the reliability of medical research. In: Solomon M, Simon JR, Kincaid H (eds) The Routledge companion to philosophy of medicine. Routledge, London, pp 232–241Google Scholar
  5. Austin JL (1962) How to do things with words. Oxford University Press, OxfordGoogle Scholar
  6. Baker M (2015) Over half of psychology studies fail reproducibility test. Nat News.  https://doi.org/10.1038/nature.2015.18248 CrossRefGoogle Scholar
  7. Boniolo G (2003) Kant’s explication and Carnap’s explication: the redde rationem. Int Philos Q 43(3):289–298CrossRefGoogle Scholar
  8. Boniolo G (2016) Molecular medicine: the clinical method enters the lab. In: Boniolo G, Nathan MJ (eds) Philosophy of molecular medicine. Routledge, London, pp 23–42CrossRefGoogle Scholar
  9. Carnap R (1950) Logical foundations of probability. University of Chicago Press, ChicagoGoogle Scholar
  10. Cartwright N (2007) Are RCTs the gold standard? BioSocieties 2(1):11–20CrossRefGoogle Scholar
  11. Chiffi D, Pietarinen A-V (2019) Clinical equipoise and moral leeway: an epistemological stance. Topoi 38(2):447–456CrossRefGoogle Scholar
  12. Chiffi D, Zanotti R (2017) Fear of knowledge: clinical hypotheses in diagnostic and prognostic reasoning. J Eval Clin Pract 23(5):928–934CrossRefGoogle Scholar
  13. Clarke B, Gillies D, Illari P, Russo F, Williamson J (2014) Mechanisms and the evidence hierarchy. Topoi 33(2):339–360CrossRefGoogle Scholar
  14. Clinical Epidemiological Round (Canadian Medical Association) (1981) How to read clinical journals: III. To learn the clinical course and prognosis of disease. CMAJ 124(7):869–872Google Scholar
  15. Dans AL, Dans LF, Guyatt GH, Richardson S (1998) Users’ guides to the medical literature: XIV. How to decide on the applicability of clinical trial results to your patient. JAMA 279(7):545–549CrossRefGoogle Scholar
  16. Djulbegovic B (2007) Articulating and responding to uncertainties in clinical research. J Med Philos 32(2):79–98CrossRefGoogle Scholar
  17. Djulbegovic B, Guyatt GH, Ashcroft RE (2009) Epistemologic inquiries in evidence-based medicine. Cancer Control 16(2):158–168CrossRefGoogle Scholar
  18. Eddy DM (1984) Variations in physician practice: the role of uncertainty. Health Affairs 3(2):74–89CrossRefGoogle Scholar
  19. Federspil G, Vettor R (2001) La “evidence-based medicine”: una riflessione critica sul concetto di evidenza in medicina. Ital Heart J 2(6 Suppl):614–623Google Scholar
  20. Fineout-Overholt E, Mazurek Melnyk B (2004) Evaluation of studies of prognosis. Evid Based Nurs 7(1):4–8CrossRefGoogle Scholar
  21. Fuller J (2018) Meta-research evidence for evaluating therapies. Philos Sci 85(5):767–780CrossRefGoogle Scholar
  22. Fuller J (2019) The myth and fallacy of simple extrapolation in medicine. Synthese.  https://doi.org/10.1007/s11229-019-02255-0 CrossRefGoogle Scholar
  23. Fuller J, Flores LJ (2015) The risk GP model: the standard model of prediction in medicine. Stud Hist Philos Sci C 54:49–61Google Scholar
  24. Giaretta P, Chiffi D (2018) Varieties of probability in clinical diagnosis. Acta Baltica Historiae et Philosophiae Scientiarum 6(1):5–27CrossRefGoogle Scholar
  25. Giaretta P, Federspil G (1998) Il procedimento clinico - Analisi logica di una diagnosi. Piccin, PadovaGoogle Scholar
  26. Greenhalgh T (2010) How to read a paper: the basics of evidence-based medicine. Wiley, ChichesterGoogle Scholar
  27. Hempel CG (1965) Science and human values. In: Spiller RE (ed) Aspects of scientific explanation and other essays in the philosophy of science. The Free Press, New York, pp 81–96Google Scholar
  28. Ioannidis JP (2005) Why most published research findings are false. PLoS Med 2(8):e124CrossRefGoogle Scholar
  29. Ioannidis JP (2008) Why most discovered true associations are inflated. Epidemiology 19(5):640–648CrossRefGoogle Scholar
  30. Keynes JM (1948) A treatise on probability. Macmillan, LondonGoogle Scholar
  31. Lim LSH, Feldman BM (2013) The risky business of studying prognosis. J Rheumatol 40(1):9–15CrossRefGoogle Scholar
  32. Macagno F, Walton D (2011) Reasoning from paradigms and negative evidence. Pragmat Cognit 19(1):92–116CrossRefGoogle Scholar
  33. McShane LM, Altman DG, Sauerbrei W, Taube SE, Gion M, Clark GM (2006) REporting recommendations for tumor MARKer prognostic studies (REMARK). Breast Cancer Res Treat 100(2):229–235CrossRefGoogle Scholar
  34. Mebius A, Kennedy AG, Howick J (2016) Research gaps in the philosophy of evidence-based medicine. Philos Compass 11(11):757–771CrossRefGoogle Scholar
  35. Mises L (1966) Human action, a treatise on economics. Henry Regnery, ChicagoGoogle Scholar
  36. Moons KGM, Royston P, Vergouwe Y, Grobbee DE, Altman DG (2009) Prognosis and prognostic research: what, why, and how? BMJ 338:b375CrossRefGoogle Scholar
  37. Moons KGM, Hooft L, Williams K, Hayden JA, Damen JAAG, Riley RD (2018) Implementing systematic reviews of prognosis studies in Cochrane. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.ed000129 CrossRefGoogle Scholar
  38. Morrison SJ (2014) Reproducibility project: cancer biology: time to do something about reproducibility. eLife 3:e03981CrossRefGoogle Scholar
  39. Pietarinen A-V, Bellucci F (2014) New light on Peirce’s conceptions of retroduction, deduction, and scientific reasoning. Int Stud Philos Sci 28(4):353–373CrossRefGoogle Scholar
  40. Porta M (2014) A dictionary of epidemiology, 6th edn. Oxford University Press, New YorkCrossRefGoogle Scholar
  41. Post PN, de Beer H, Guyatt GH (2013) How to generalize efficacy results of randomized trials: recommendations based on a systematic review of possible approaches. J Eval Clin Pract 19(4):638–643CrossRefGoogle Scholar
  42. Riley RD, Hayden JA, Steyerberg EW, Moons KGM, Abrams K, Kyzas PA et al (2013) Prognosis Research Strategy (PROGRESS) 2: prognostic factor research. PLoS Med 10(2):e1001380CrossRefGoogle Scholar
  43. Riley RD, van der Windt D, Croft P, Moons KG (eds) (2019) Prognosis research in healthcare: concepts, methods, and impact. Oxford University Press, OxfordGoogle Scholar
  44. Rizzi DA (1993) Medical prognosis—some fundamentals. Theor Med 14(4):365–375CrossRefGoogle Scholar
  45. Sadegh-Zadeh K (2012) Handbook of analytic philosophy of medicine. Springer, DordrechtCrossRefGoogle Scholar
  46. Schulz PJ (2006) The communication of diagnostic information by doctors to patients in the consultation. In: Kalitzkus V, Twohig PL (eds) Bordering biomedicine. Rodopi, Amsterdam, pp 103–118Google Scholar
  47. Searle JR (1969) Speech acts: an essay in the philosophy of language. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  48. Stegenga J (2018) Medical nihilism. Oxford University Press, OxfordCrossRefGoogle Scholar
  49. Stovitz SD, Shrier I (2019) Causal inference for clinicians. BMJ 24(3):109–112Google Scholar
  50. Thorne S, Sawatzky R (2014) Particularizing the general: sustaining theoretical integrity in the context of an evidence-based practice agenda. Adv Nurs Sci 37(1):5–18CrossRefGoogle Scholar
  51. Walker MJ, Bourke J, Hutchison K (2019) Evidence for personalised medicine: mechanisms, correlation, and new kinds of black box. Theor Med Bioeth 40(2):103–121CrossRefGoogle Scholar
  52. Woods J, Walton D (1978) The fallacy of ‘ad ignorantiam’. Dialectica 32(2):87–99CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.DAStUMilanItaly
  2. 2.Department of Philosophy and Educational Sciences, University of TurinTurinItaly

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