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An Additional Basic Science for Clinical Medicine: I. The Constraining Fundamental Paradigms

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This series of articles is an expansion of a lecture presented on 19 April 1982 at the Annual Session of the American College of Physicians.

▸Requests for reprints should be addressed to Alvan R. Feinstein, M.D.; Clinical Epidemiology Unit, Yale University School of Medicine, 333 Cedar Street, P.O. Box 3333; New Haven, CT 06510.

New Haven, Connecticut

© 1983 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1983;99(3):393-397. doi:10.7326/0003-4819-99-3-393
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The four main conceptual paradigms of basic biomedical research are that the explication of mechanisms is a primary goal of science; that scientific data must be "hard"; that formulation of hypotheses and counter-hypotheses is a principal creative challenge; and that experiments are the main mechanism for using scientific methods to conduct investigations. Although suitable for the spectacular accomplishments of biomedical research, these paradigms do not offer a satisfactory foundation for the additional basic science needed in the managerial decisions of patient care. For these decisions, the primary scientific goal is usually prediction rather than explication alone; the crucial data often involve "soft" information about clinical and personal phenomena; and the main creative challenge is to develop an improved methodology for getting adequate data and making unbiased comparisons. Although the experiments conducted as randomized clinical trials have been scientifically helpful, the improved methods will have to include evidence obtained in the often unplanned "experiments" of ordinary clinical practice.





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