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J Am Med Inform Assoc. 2010 Jan-Feb; 17(1): 112–113.
PMCID: PMC2995637

The author's response

I thank Dr Hunter for his insightful comments on my paper. I would like to add some observations in response to his.

I agree that the “fundamental theorem” as expressed in the paper is silent on method and does not explicate how the person-plus-technology actually becomes better than the person unassisted. The scientific method certainly plays a significant role in this process when the pertinent domain of activity is scientific research.

At the same time, the fundamental theorem applies to many domains of work. These domains include research, of course. In that case, the “person” portrayed in the theorem is a scientist. Other pertinent domains are healthcare (in which case the person is a practitioner or a consumer), education (where the person is a student or a teacher), and administration (where the person is a manager).

While I agree that the scientific method plays a profound role in making the person better in the domain of research, it is less clear that the scientific method applies directly to the domains of healthcare, education, and administration. For example, in healthcare, a significant body of literature suggests that clinicians do not routinely use hypothetico-deductive reasoning, as described by Dr Hunter. As powerful as this approach can be for the discovery of new knowledge, it is generally inefficient for the application of existing knowledge. Evidence suggests that experienced clinicians use a highly efficient inductive pattern-matching process to arrive at most diagnoses, and employ the scientific method only when the patient's problem does not fit a known pattern.

So, I would agree that the scientific method plays a prominent role in making the theorem work but does this primarily in only one of the domains to which the theorem applies. Its role in the other domains is less clear and almost certainly less profound. For that reason, I am much less confident that the scientific method should be included in a general reformulation of the theorem.


Competing interests: None.

Provenance and peer review: Commissioned; not externally peer reviewed.

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