Ockham Meets Bayes
Keywords:Diagnosis, Parsimony, Bayes, Ockham's Razor, Probability
AbstractOckham’s razor is the idea that simpler hypotheses are to be preferred over more complex ones. In the context of medical diagnosis, this is taken to mean that when a patient has multiple symptoms, a single diagnosis should be sought that accounts for all the clinical features, rather than attributing a different diagnosis to each. This paper examines whether diagnostic parsimony can be justified by reference to probability theory. I argue that while attempts to offer universal justifications of diagnostic parsimony fail, a more constrained use of this diagnostic principle can be supported.
Djulbegovic, Benjamin, Jef van den Ende, Robert M. Hamm, Thomas Mayrhofer, Iztok Hozo, and Stephen G. Pauker. 2015. “When Is Rational to Order a Diagnostic Test, or Prescribe Treatment: The Threshold Model as an Explanation of Practice Variation.” European Journal of Clinical Investigation 45, no. 5: 485–493. https://doi.org/10.1111/eci.12421.
Fraser, Hamish, Enrico Coiera, and David Wong. 2018. “Safety of Patient-Facing Digital Symptom Checkers.” The Lancet 392, no. 10161: 2263–2264. https://doi.org/10.1016/s0140-6736(18)32819-8.
Freixa, Marta, André F. Simões, Joana Barbosa Rodrigues, Sara Úria, and Glória Nunes da Silva. 2019. “Occam’s Razor versus Hickam’s Dictum: Two Very Rare Tumours in One Single Patient.” Oxford Medical Case Reports 2019, no. 5: 195–198. https://doi.org/10.1093/omcr/omz029.
Goodman, Nelson. 1958. “The Test of Simplicity.” Science 128, no. 3331: 1064–1069. https://doi.org/10.1126/science.128.3331.1064.
Hilliard, Anthony A., Steven E. Weinberger, Lawrence M. Tierney, David E. Midthun, and Sanjay Saint. 2004. “Occam’s Razor versus Saint’s Triad.” New England Journal of Medicine 350, no. 6: 599–603. https://doi.org/10.1056/nejmcps031794.
Jefferys, William H. and James O. Berger. 1992. “Ockham’s Razor and Bayesian Analysis.” American Scientist 80, no. 1: 64–72. https://www.jstor.org/stable/29774559.
Jolobe, Oscar. 2016. “Caveats to the Application of Diagnostic Parsimony.” QJM 109, no. 2: 143. https://doi.org/10.1093/qjmed/hcv157.
Kemeny, John G. 1953. “The Use of Simplicity in Induction.” Philosophical Review 62, no. 3: 391–408. https://doi.org/10.2307/2182878.
MacKay, David. 2003. Information Theory, Inference and Learning Algorithms. Cambridge: Cambridge University Press.
Mayo, Deborah G. 1996. Error and the Growth of Experimental Knowledge. Chicago: University of Chicago Press.
Pauker, Stephen G. and Jerome P. Kassirer. 1975. “Therapeutic Decision Making: A Cost Benefit Analysis.” New England Journal of Medicine 293, no. 5: 229–234. https://doi.org/10.1056/nejm197507312930505.
———. 1980. “The Threshold Approach to Clinical Decision Making.” New England Journal of Medicine 302, no. 20: 1109–1117. https://doi.org/10.1056/NEJM198005153022003.
Plutynski, Anya. 2005. “Parsimony and the Fisher-Wright Debate.” Biology and Philosophy 20, no. 4: 697–713. http://dx.doi.org/10.1007/s10539-004-7044-0.
Popper, Karl R. 1959. The Logic of Scientific Discovery. London: Hutchinson.
Richardson, W. Scott. 2007. “We Should Overcome the Barriers to Evidence-Based Clinical Diagnosis.” Journal of Clinical Epidemiology 60, no. 3: 217–227. https://doi.org/10.1016/j.jclinepi.2006.06.002.
Savage, Leonard J. 1954. The Foundations of Statistics. New York: John Wiley & Sons.
Schattner, Ami. 2015. “Teaching Clinical Medicine: The Key Principals.” QJM 108, no. 6: 435–442. http://dx.doi.org/10.1093/qjmed/hcv022.
———. 2016. “Caveats to the Application of Diagnostic Parsimony—Reply.” QJM 109, no. 2: 144. http://dx.doi.org/10.1093/qjmed/hcv161.
Sober, Elliott. 1988. Reconstructing the Past: Parsimony, Evolution and Inference. Cambridge, MA: MIT Press.
———. 1990. “Explanation in Biology: Let’s Razor Ockham’s Razor.” Royal Institute of Philosophy Supplement 27: 73–93. http://dx.doi.org/10.1017/S1358246100005051.
———. 2015. Ockham’s Razors: A User’s Manual. Cambridge: Cambridge University Press.
Sox, Harold C., Michael C. Higgins, and Douglas K. Owens. 2013. Medical Decision Making. Oxford: Wiley-Blackwell.
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