title: Medicine is not science: guessing the future, predicting the past.
abstract: OBJECTIVE
  Irregularity limits human ability to know, understand and predict. A better understanding of irregularity may improve the reliability of knowledge.
  
  
  METHODS
  Irregularity and its consequences for knowledge are considered.
  
  
  RESULTS
  Reliable predictive empirical knowledge of the physical world has always been obtained by observation of regularities, without needing science or theory. Prediction from observational knowledge can remain reliable despite some theories based on it proving false. A naïve theory of irregularity is outlined. Reducing irregularity and/or increasing regularity can increase the reliability of knowledge. Beyond long experience and specialization, improvements include implementing supporting knowledge systems of libraries of appropriately classified prior cases and clinical histories and education about expertise, intuition and professional judgement.
  
  
  CONCLUSIONS
  A consequence of irregularity and complexity is that classical reductionist science cannot provide reliable predictions of the behaviour of complex systems found in nature, including of the human body. Expertise, expert judgement and their exercise appear overarching. Diagnosis involves predicting the past will recur in the current patient applying expertise and intuition from knowledge and experience of previous cases and probabilistic medical theory. Treatment decisions are an educated guess about the future (prognosis). Benefits of the improvements suggested here are likely in fields where paucity of feedback for practitioners limits development of reliable expert diagnostic intuition. Further analysis, definition and classification of irregularity is appropriate. Observing and recording irregularities are initial steps in developing irregularity theory to improve the reliability and extent of knowledge, albeit some forms of irregularity present inherent difficulties.
authors: Imperial College, London, UK.
authors: Clifford
authors: C
authors: Miller
mesh_terms: D015510:Clinical Medicine / Q000592:standards / Q000639:trends*; D019317:Evidence-Based Medicine / Q000592:standards / Q000639:trends*; D005544:Forecasting; D006801:Humans; D019545:Intuition; D019359:Knowledge; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012586:Science / Q000592:standards / Q000639:trends*
keywords: complexity; evidence-based medicine; expert judgement; intuition; irregularity theory; observational knowledge