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Medical science is now synonymous with probability-based statistics. Statistics deals with a group; it does not need probability theory. Probability theory is consistent with the worldview that the universe is infinite, bounded, random, and governed by chance. Its logic is binary, its geometry is Cartesian, its rules offer a scientific method by which hypotheses may be tested. Clinical trials and even hypothesis testing at the bedside have nestled into the probability foundation. As a result, scientific “evidence” now appears only through the lens of probability theory. Because there is no definitive truth in the worldview of probability theory, the truth of evidence lies in probabilities only. The probabilistic view of science has a firm impact on the practice of medicine and implications for medical–legal decisions.
The evidence in “evidence-based medicine” might be based on scientific principles and not exclusively on probability-based statistics. Although probability-based statistics has a role in the evidence structure of clinical epidemiology, it need not dominate the evidence structure of medical practice. The hard-won principles of pathophysiology developed by clinical medicine and laboratory research constitute the core principles of medical evidence. Probability-based statistics now masquerades as the foundation of medical research, but clinical decisions are made with regard to the individual patient, who is a unique microcosm of physiologic, genetic, and biochemical processes [1•]. Evidence-based medicine must be liberated from bondage to probability-based statistics, which is founded on the notion of chance and random processes, and instead become established on the determinate processes of molecular biology, based on the universal principles of biological science. The current bondage of evidence-based medicine to probability-based statistics has led to a mindset on the part of the physician that leads to the misapplication of statistics to the diagnosis and treatment of the individual patient and to the definition of standard of care.
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