--- Roger Ekins <[log in to unmask]> wrote: > >Roger
Ekins wrote: At the same time the experience
> garnered over the
> >years by people such as yourself will need to be
> incorporated into
> >expert systems since it will be impossible for
> individuals otherwise
> >to cope with the information flow they will face.
> >
>
> Well I understand Trevor Tickner's  point - put
> shortly,  that a lot
> of what we hear and read is myth.  And I've fought
> against a lot of
> mythology in my time.  Even - to take a case in
> point - the invention
> of microarray technology came about because I
> contested deeply
> entrenched and widely accepted  myths relating to
> ligand assay
> design, some of them emanating from Nobel Laureates.
>  And last week I
> gave a lecture in Italy explaining  (mathematically)
> why the free
> hormone hypothesis  may be a myth, and offering
> reasons for  the
> existence (currently unknown) of hormone binding
> proteins in
> mammalian blood.
>
> But that we are not still hanging from the trees is
> a consequence of
> our ability to share experience with others by the
> use of speech and
> the written word, enabling us to benefit from such
> experience even
> though much of this may be ill remembered and 99%
> may be junk.
>
> A book is an expert system - and of course we should
> be wary of what
> we read. But that much of what we read is untrue
> does not make it
> sensible to burn all our books (which seems to be
> the logic of Trevor
> Tickner's position)  but to engage in the slow
> laborious process of
> separating the wheat from the chaff, and conserving
> the former.
>
> I don't disagree with Trevor Tickner's views on how
> a clinical
> scientist should conduct his professional affairs,
> but I'm not sure
> that he has caught up with the likely flood of
> information that
> modern analytical technologies will generate, and
> the challenge that
> this will present to the diagnostician.  No longer
> will he/she be met
> with "a piece of data that identifies the patient as
> belonging to (or
> excluded from) a particular population" but a
> hundred pieces of data,
> genomic, proteomic, and the like.
>
> I wonder whether Trevor Tickner will live long
> enough to be able to
> sort this out without relying on the accumulated,
> collective,
> experience of others.  For my own sake, I hope so.
>
> Roger Ekins
>
> Molecular Endocrinology
> University College London Medical School
> London W1N 8AA
>
> Fax +44 20 7580 2737
> Phone +44 20 7679 9410
>
>
>
> >I do hope that we shall resist the temptation to
> incorporate our
> >experience (personal or collective) into expert
> systems.
> >
> >All too often experience is nothing more than a
> vague memory of a
> >pattern that we saw when fairly junior and which
> was attributed by
> >some long retired physician with, for all we know,
> the credentials
> >of Egerton Yorrick Davis (see, for example,
>
><http://www.museumofhoaxes.com/yorrick.html>http://www.museumofhoaxes.com/yorrick.html
> )
> >as condition X.
> >
> >Improvements in technology have removed from the
> clinical laboratory
> >much of the necessity for practical skills from
> those that were
> >essential 40 or so years ago. Those developing
> analyses based upon
> >new technologies often work in the commercial
> sector but they are
> >none-the-less clinical scientists. Those who remain
> in hospitals or
> >universities need to develop concepts of data
> analysis that
> >concentrate on the nature of disease or on the
> nature of medical
> >decisions.
> >
> >There are numerous hypotheses about the aetiology
> and pathogenesis
> >of disease and 'responsible' genes are reported
> almost daily. Robert
> >Koch drew up his famous postulates whereby 'proof'
> of cause could be
> >firmly established over 100 years ago. Such rigour
> is lacking in
> >today's clinical laboratory.
> >
> >Tomorrow's clinical scientist must surely be that;
> an individual who
> >uses scientific method and logic to analyse data. A
> piece of data
> >identifies the patient as belonging to (or excluded
> from) a
> >particular population within which risk may be
> assigned.
> >Alternatively one may look for evidence of
> precedence either in the
> >pathogenic process of in that of medical decision
> making.
> >
> >Analysis of medical decisions shows the experience
> of the clinician
> >often to be little more than an additional variable
> in the process.
> >
> >I believe that we should be extremely wary of
> experience lest,
> >like William Osler's practical joke, it becomes the
> dogma against
> >which future generations of scientists have to
> fight.
> >
> >Trevor Tickner
> >Norwich
>
>
> --
>
>
>
>
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