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Clinical Research Transformed

  • Olli S. Miettinen
  • Johann Steurer
  • Albert Hofman
Book

Table of contents

  1. Front Matter
    Pages i-xxiv
  2. Part I

    1. Front Matter
      Pages 1-1
    2. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 3-8
    3. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 9-14
    4. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 15-29
    5. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 31-36
  3. Part II

    1. Front Matter
      Pages 37-37
    2. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 39-49
    3. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 51-57
  4. Part III

    1. Front Matter
      Pages 59-59
    2. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 61-70
    3. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 71-74
  5. Part IV

    1. Front Matter
      Pages 75-75
    2. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 77-80
    3. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 81-88
    4. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 89-98
    5. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 99-108
    6. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 109-114
    7. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 115-123
  6. Part V

    1. Front Matter
      Pages 125-125
    2. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 127-135
    3. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 137-144
    4. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 145-157
  7. Part VI

    1. Front Matter
      Pages 159-159
    2. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 161-167
    3. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 169-192
    4. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 193-213
    5. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 215-232
    6. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 233-242
  8. Part VII

    1. Front Matter
      Pages 243-243
    2. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 245-247
    3. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 249-253
    4. Olli S. Miettinen, Johann Steurer, Albert Hofman
      Pages 255-260
  9. Back Matter
    Pages 261-302

About this book

Introduction

This book delineates the fundamental transformations that, according to its precepts,
are now needed in the objects and methods of ‘patient-oriented’ clinical research, in
order to make it genuinely patient-relevant. These transformations are presented as
providing for transition from today’s ‘evidence-based’ practices (advocated by ‘clinical
epidemiologists’) to knowledge-based succedanea of these. While those existing
practices vary according to doctors’ personal opinions about the burden of the available
evidence, their knowledge-based succedanea will be essentially invariant across
individual doctors, as they’ll be guided by ‘expert systems’ (imbedded in cyberspace). At
issue in this is transformation in what the authors present as the very essence of clinical
medicine, namely clinical doctors’ esoteric ad-hoc knowing: “gnosis.” This is clinical
doctors’ knowing — probabilistic — about relevant-but-hidden truths about their patients’
health, and constitutes the basis for their teaching (“doctoring”) the patients about these
esoteric insights. The probabilities are ‘personalized’ in the meaning of their specificity
to the cases’ gnostic profiles.

Genuinely patient-relevant clinical knowledge this book presents as the requisite
basis for three species of clinical doctors’ gnosis: diagnosis — knowing about whether a
particular type of illness is present (though hidden) in the patient; etiognosis — knowing
about whether the patient’s illness was caused by a particular antecedent of it; and
prognosis — knowing about the patient’s future health, including as to its dependence
on the choice of treatment. Pivotal in gnostic clinical research this book presents to be
the studies’ objects design in terms of a statistical model for the rate of occurrence of
the entity of health in question, in a defined domain of case presentations. The
essentials of the studies’ methods designs are deduced from their objects designs.

Study of this book — on the theory of “meta-epidemiological clinical research” — is
essential preparation for teaching ‘patient-oriented’ clinical research and for actual
design & conduct of the studies and of their critical reviews. And by the same token,
study of this book is essential preparation for the needed replacement of ‘case-based
learning’ of clinical medicine, for suitably-learned teaching of the practice of clinical
medicine — focused on the status quo of the scientific knowledge-base for (gnoses in)
the discipline (‘specialty’) at issue.

Keywords

epidemiology gnostic research logistic regression etiognostic research statistics

Authors and affiliations

  • Olli S. Miettinen
    • 1
  • Johann Steurer
    • 2
  • Albert Hofman
    • 3
  1. 1.Faculty of Medicine, McGill University, Montreal, QC, Canada, Department of MedicineWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Horten Center for Patient-oriented Research and Knowledge TransferUniversity of ZürichZürichSwitzerland
  3. 3.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA

Bibliographic information