Prediction in medicine: philosophical reflections

Reflection by Jonathan Fuller on N=1

The final session of the CauseHealth N = 1 workshop explored prediction in medicine; it involved me and Alex Broadbent. Alex previously pointed out that the topic of prediction has scarcely been explored by philosophers, let alone the topic of prediction in epidemiology or medicine. Yet predictions are absolutely crucial for the practice of medicine. Physicians predict how their patients will fare given their present health state (prognosis) as well as how intervention will alter the natural course of events (therapy); in a broader sense of prediction, they also predict the patient’s diagnosis. At N = 1, Alex called the ability to predict well a ‘core clinical competency’, while I referred to the challenge of predicting for patients a ‘central aim of medicine’.

Given the importance of prediction in medicine, several important tasks are before the philosopher who wishes to understand medical practice. The first task is to understand the structure of predictive inferences – from study results, from theory, from personal experience, and from other sources of evidence. The second task is to explore the goodness of these inferences – what are their strengths and weaknesses, when do they hold up and when do they fall apart? Another challenge, one requiring the faculty of imagination, is to envision how we might predict differently – better – using the kinds of evidence at our disposal.

Philosophy can help, and interdisciplinary workshops like N = 1 are an ideal forum for the kind of imaginative dialogue that is exactly what the doctor (of medicine and of philosophy) ordered.