On Medical Truth
Abstract
Since the advent of the natural sciences, natural scientists have spread the
idea that the pursuit of truth about the facts of the world is the main drive of
scientific research. The aim, they say, is to acquire knowledge and to provide
explanations and predictions of phenomena and events. Surprisingly, even
in our contemporary world in which scientific research is strongly involved
in seeking solutions to practical problems pertaining to the pursuit of food,
water, energy, health, labor, peace, war, nuclear weapons, money, and the like,
the pursuit-of-truth postulate nevertheless enjoys vigorous advocacy, especially
in philosophy. In this chapter, the role that truth actually plays in medicine will be examined. Our discussion of this issue divides into the following four sections: 24.1 Truth in Medical Sciences; 24.2 Truth in Clinical Practice; 24.3 Misdiagnoses; 24.4 Truth Made in Medicine.
In summary, it is shown that medical knowledge does not contain much truth because it mainly consists of hypotheses, theories, and deontic rules. The truth values of the former are unknown, while theories and deontic rules do not assume truth values. Likewise, in clinical practice true diagnoses and prognoses are not always attainable because (i) medical knowledge is inevitably vague, uncertain, and unreliable and is therefore scarcely truth-conducive; (ii) this also applies to most parts of patient data; (iii) physicians are not trained in viable and efficient methodology of clinical reasoning; and (iv) neither clinical decision support systems
nor the automation of clinical decision-making will be able to compensate for
the first two shortcomings. So, misdiagnoses will remain inevitable forever,
although their frequency may be reduced by improving the techniques of clinical
judgment. Since medical theories are artifactual structures and medical
languages are artifactual systems, the truth of diagnoses and prognoses, and
of any other judgment based thereon is made in medicine.