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Clinical Epidemiology & Evidence-Based Medicine
Glossary:
Science Terminology
Updated
July 15, 2005
Section Contents:
Scientific Literature:
- Literature: The written repository of medical knowledge. It includes
information sources such as: refereed scientific journals, practice oriented review
journals, conference proceedings, trade journals, textbooks, product promotion materials,
and internet e-mail communications, all which vary widely in strength of evidence.
- Primary Source:
The information source from which evidence-based knowledge is
derived. It has as a major component evidence derived directly from fully described (or
referenced) formal observation, procedures or experiments performed with valid,
scientifically accepted methods. In its strongest form, this material is usually (but not
only) a paper in a refereed scientific publication.
- Scientific Refereed Journal:
A journal that has a mission of publicizing and storing
primary scientific evidence. By convention evidence published in such a journal is
subjected to anonymous review by several experts (referees) in the field prior to
publication and is published only once. The methods used to acquire the evidence must be
described (or a primary reference cited) with sufficient detail that a person
knowledgeable in the discipline can critically appraise the study and could replicate it
if they so desired. Note that although the review process is the best we have for
assuring evidence integrity, a significant proportion of such papers contain serious flaws
in methods and interpretation, some which render the study invalid. The presence of
these flaws is one of the primary reasons why literature assessment is a critical skill
for clinicians. Repetition of the study by another research group, either in whole or in
part, may support or refute a previous study. The critical reader looks for these
additional studies.
- Scientific Proceedings:
A collection of current research reports, usually presented
as brief abstracts, from a scientific meeting. These are a much weaker form of a primary
source than is a full scientific journal article because the selection of the abstracts,
which are of varying quality, is based on a much more cursory review, the reports are
usually incomplete, and much of the work is in-progress. As such, these represent a form
of "pre-primary" source. Only half of the studies presented as abstracts ever
appear in scientific journals, the balance for example not surviving the scientific
publication review process or having findings that are reversed after collecting more
data. The problem for the user is to decide which half.
- Integrative Source (Studies):
A source reporting the results of meta-analysis, which
is a statistical procedure to mathematically combine the results from a number of valid
studies to arrive at a stronger conclusion. An exhaustive search for all of the studies
relevant to the question at hand and a critical analysis of these studies to exclude those
with serious design or procedural flaws is required. Integrative studies are based on
objective quantitative analysis rather than the more subjective analysis of the
conventional critical review. In human medicine, these reviews are being performed on the
primary sources for selected areas of clinical care and are being compiled in Cochrane
Collaboration databases to provide a stronger basis for the practice of evidence-based
medicine.
- Secondary Source:
An information source that does not have as a major component the
description of formal observations or experiments but rather is synthesized from some
combination of primary sources, experience, or authoritative belief (dogma). The primary
literature used may have been selected in a biased or incomplete fashion and may have been
used without comprehensive critical appraisal to establish the relative strength of
evidence in each source. Examples of secondary sources are review articles, journals
specializing in practitioner-oriented reviews, most practitioner-oriented conference
proceedings, trade publications, most e-mail conversations, and authorities presenting
information without supporting evidence in whatever format (lectures, CE meetings, e-mail
forums).
- Tertiary Source:
A compilation of information for application across a broad
spectrum, typically represented by class notes and textbooks intended for use in core
courses. The information is often presented in a dogmatic, authoritative fashion as a
sequence of facts and interpretations of their meaning that the reader is to believe
without reservation or evaluation. The strength of the underlying evidence is not
indicated and any current controversy between researchers in the area is not addressed.
The bibliography is usually predominately secondary literature and is usually intended to
provide the interested reader with entry points to the underlying primary literature. Much
of the evidence-based information contained in textbooks is filtered sufficiently that it
is accepted by most all of the experts in the field, much of it is unlikely to change in
the future, and most of the changes will be minor. However, depending on the field,
textbooks contain a varying amount of dogma and interpretations of facts that will change
with the progress of research in the area, sometimes significantly. Because clinical
experience is often not examined critically, clinical textbooks tend to contain a larger
proportion of dogma than do basic science textbooks. Class notes usually contain much more
limited information than do textbooks and do not undergo the auditing process as part of
publication as textbooks do.
- Derivative Service:
A service that presents collections of abstracts, usually from a
wide selection of primary literature, selected to meet the interests of a particular group
of clinicians. Some, such as Medline, reproduce a copy of the abstract as written by the
authors of the primary publication. These are often truncated if longer than some maximum
limit, such as 250 words. Others, such as CAB Vet-CD, contain abstracts written by the
derivative service rather than the authors of the original publication. Abstracts vary in
quality and abstracters may interpret the evidence of the paper differently than intended
by the original authors.
- Structured Abstract:
An abstract format, adopted by many clinical journals, that
generally contains the key components of study population and source, study question,
study design, main findings, and clinical implication in a dense outline format. This
format was developed because unstructured abstracts are of varying quality, often omitting
key components, and many clinicians, particularly those using the derivative sources, read
only the abstracts because of time constraints.
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Science (General Terms):
- Scientific Research: The systematic, controlled, empirical and critical
investigation of hypothetical propositions about the presumed relations among natural
phenomena (Kerlinger, 1964). The objective inquiry into natural phenomena using currently
accepted investigation procedures, the immediate product of which is evidence, with the
objective of discovering how that aspect of the physical world works. It is an empirical,
conceptual system of learning about the physical world that organizes publicly observable
facts and reasoning within a structure of theories and inferences. The methods of inquiry
are constructed to minimize the effects of natural human biases in observation and
interpretation. By convention, the evidence, the procedures used to acquire it, and
subsequent interpretation is subjected to peer evaluation as a prelude to publication in
the primary literature where it is publicly available for further scrutiny and use.
- Scientific Knowledge:
The current set of peer-evaluated consensus models about how
natural phenomena work, which often differ between groups of researchers at the research
frontier. These models are established by evidence obtained from critical scientific
inquiry that has been subjected to peer evaluation and replication. All scientific
knowledge contains varying degrees of uncertainty and is constantly at varying risk of
being modified or discarded as the result of evidence from further inquiry. Models are
disproved by multiple findings of discrepant evidence, which is often the result of
improvements in measurement technology. Discrepant findings are weakened by failure of
legitimate independent replication and are strengthened by their success. Many repeated
studies of the same design and execution that result in the same evidence do not
significantly increase the likelihood that the model of the phenomena is correct.
Similarly, a belief is not strengthened (converted to knowledge) by the weight of the
number of people who hold it.
- Scientific Paradigm: The model shared by most but not all members of a
scientific community, designed to describe and interpret observed or inferred phenomena,
past or present, and aimed at building a testable body of knowledge open to rejection or
confirmation. (Shermer, 1977)
- Scientific Progress: The cumulative growth of a system of knowledge over time, in
which useful features are retained and nonuseful features are abandoned, based on the
rejection or confirmation of testable knowledge. (Shermer, 1997) Important components of
this progress are the evolution of the experimental and observation methods and the public
presentation of findings in the refereed primary scientific literature for expansion,
support (corroboration) or refutation (rejection) of previous findings and
interpretations.
- Belief: The mental act or state of mind of an individual after they accept and
internalize an external concept or idea, which then becomes part of further thought
processes, often unrecognized, on related issues. Internalized deeply, belief becomes part
of intuition. Belief can occur after deliberate, systematic, critical thinking or can
occur with immediate, non-reasoned, uncritical acceptance. Once a belief is accepted that
is in error, accepting a more correct belief becomes considerably more difficult than if
no previous belief were held. The nature of human thinking is to weigh data that is
consistent with the mistaken belief heavier and to ignore or discount discordant data, and
to limit the search for additional data to that which has the potential of confirming
rather than refuting a belief (e.g. selective necropsy to confirm a gross diagnosis).
Prior belief biases subjective observation, such as occurs during the diagnostic process
or during non-blinded measurement, because it subtly changes perception, particularly of
vague or ambiguous characteristics. This bias occurs unbeknownst to the observer and
despite their best intentions.
- Dogma:
Those beliefs held as established or put forth as an authoritative or expert
opinion, often contained in a secondary or tertiary source, but that have little or no
supportive empirical evidence from primary sources. Medical dogma is usually derived from
unevaluated biological hypotheses and uncritical observation or experience without
recognition of the effects of chance, natural biological variation, and observer bias. An
unknown but significant portion of medical practice falls into this category. Repetition
across secondary and tertiary sources or the number of people, whatever their
qualifications, that hold this belief does not change the status of such information. Most
information conveyed in the instructional setting is given in the form of dogma without
the associated information necessary to judge its credibility.
- Evidence:
That which tends to support something or show that something is the case.
Depending on how it was obtained, evidence varies greatly in strength. Note that a set of
evidence can be correct but the underlying theory that the promoters allege the evidence
supports can still be wrong.
- Empirical Evidence (Facts):
Knowledge obtained by looking rather than reasoning or
feeling. In the scientific sense, that knowledge comprised of the objective findings (but
not broad interpretation) derived from analysis of objective data obtained from formal
observational or experimental procedures that are potentially repeatable (verifiable) and
that meet currently accepted standards of design, execution, and analysis. The strongest
empirical evidence is obtained from rigorous methods incorporated into an experiment
designed to have a clear, unequivocal supporting or refuting outcome. Empirical evidence
is weakened by the opportunity for other explanations, due to weakness in methods, to
account for the findings. As the opportunity for independent verification and for
assessment of strength of evidence is a key component, the methods used to acquire the
evidence must be described or referenced sufficiently that this verification and
assessment can be done by independent investigators. As presented even in the refereed
primary scientific journals, this evidence must be critically appraised by the reader
because, depending on the methods used, it varies from strong and useful to weak, wrong,
or irrelevant. Note that a set of evidence can be correct (e.g., the sun "rises"
regularly) but the underlying theory that the promoters allege the evidence supports is
wrong (e.g., the sun moves around the earth).
- Analogical Evidence:
Evidence based on reasoning by analogy, which is concluding
from comparing known similarities between two systems that a relationship shown to exist
in one system but unknown in the other also exists in the other. For example, if drug X
has been shown to be effective against disease Y in a species Z then perhaps the same
relationship exists between similar drug or similar disease or similar species. Evidence
based on analogical reasoning is common in medicine, as it is a necessary basis for action
when empirical evidence is lacking. Detailed mechanisms of action for particular processes
are often established in laboratory species (rodents) and extrapolated to other species in
which direct investigation is impractical. However, analogical evidence is susceptible to
unavoidable error because of the likelihood that different and unknown factors are
operating in the two systems, which weaken the analogy. Because it is inherently a weaker
form of evidence than is empirical evidence, it is likely the source of much unexamined
dogma and is better used as a basis for generating hypotheses that are then empirically
evaluated.
- Anecdotal Evidence (Case report):
The description of the occurrence of single unique
event, such as a miraculous medical recovery. Even if the occurrence of the event itself
is without doubt, the reason that it occurred is often promoted as being due to an unusual
therapy applied to the case and thus validating the theory that selection of the therapy
was based upon. The probability of apparently unusual events is often considerably higher
than we expect by intuition and other unrecognized factors (confounders) may have
invalidated the initial prediction of demise, thus making the event not that unusual. As
an anecdote is extremely weak evidence in support of a theory, an accumulation of similar
anecdotes does not significantly increase support and at best may serve as a justification
for a scientific experiment to empirically test the theory.
- Scientific Method:
The scientific method is the conceptual process of organizing
empirical facts and their inter-relationships in a structure of theories and inferences.
It is the philosophical ideal of how scientists advance scientific knowledge by
methodically and systematically applying procedures that reduce the likelihood of
alternative explanations for their observations. The underlying principles are skepticism
(an attitude of doubt toward and suspended judgment of statements, even when made by great
authorities, prior to analyzing the underlying evidence and assumptions), determinism (the
principle that all natural phenomena are caused previous events linked by fundamental
physical laws that are the same everywhere in the universe) and empiricism (the practice
of relying on observation and experiment for developing an understanding (theory) of
natural phenomena).
- Hypothetico-deductive Model:
The logical basis of the classical scientific method.
It is comprised of the rigorous logical deduction of a precise prediction (causal
hypothesis) based on the current scientific theory followed by the design and execution of
a crucial study that will have one of two unequivocal outcomes to test this causal
hypothesis, and finally the logical induction that the theory is supported or falsified
based on the findings from this study. Falsification is usually regarded as logically more
definitive than is support. Although it is a useful model of scientific logic, the
"scientific method" is only an idealized concept of the actual process by which
scientific knowledge advances.
- Deduction: Reasoning from the general theory to predict the specific
circumstance (general to specific).
- Induction: Reasoning from the results of the specific circumstance to
conclusions about the theory (specific to general).
- Scientific Model:
A concept of the way a phenomenon in nature works, usually
simplified from a theory to be useful for the purposes at hand. The usefulness of a model
often depends on the context in which it is used. For example, the model of mass movement
from Newtonian physics is adequate to predict what will happen when a car runs into a
brick wall. The model of motion based quantum physics is more correct (in the sense that
it covers more phenomena) but is not more useful and is more cumbersome in the scale of
interest to the driver of car about to hit the wall. "All models are wrong;
some are just more useful than others." (JP Box).
- Scientific Theory:
The coherent, interrelated structure of scientific propositions
and principles derived over time from scientific evidence that explains a class of
observed phenomena or facts. Theories enable us to make sense of what we see and to make
predictions. A scientific theory must have predictive power (predict phenomena that can be
observed) and must be testable and falsifiable (the theory is false if the predicted
phenomena are not observed in the appropriate experiment). A scientific theory must be
consistent both internally and with broader, more fundamental theories related to other
aspects of the phenomena. For example, a theory of disease treatment cannot be
inconsistent with most of the more fundamental theories of chemistry. Although a theory
that is consistent with a diversity of evidence generally is stronger (more certain) than
one that is not, a theory cannot be proven as an absolute certainty (absolute truth) and
is always at some risk of modification if not replacement. To replace a previously held
theory, the new theory must explain those phenomena explained by the previous theory as
well as those it did not adequately explain. Note that in non-scientific contexts the word
theory is often used to mean a mere hypothesis or speculation, a much less reliable
proposition than is a scientific theory.
- Pseudo-scientific Theory:
Theories that are claimed to be scientific but are not.
Hallmarks of pseudoscientific theories are: 1) Incompatible with broader, more fundamental
scientific theories that are supported by overwhelming evidence, 2) Violation of the
testability / falsifiability requirement; that is an experiment cannot be designed or an
observation made that the results of which would refute the theory.
- Embedded Theory: A theory whose scientific propositions have been
repeatedly tested and supported to the point that it becomes a widely accepted explanation
for the phenomena involved.
- Scientific Proof:
In the strict sense scientific proof only occurs in the
disciplines of pure mathematics and logic, where it means the sequence of statements
establishing the validity of a concluding statement in accordance with mathematical or
logical principles. Scientific theories outside of these disciplines cannot be
"proven". Scientific theories are supported by evidence, the amount of which can
be such that it is unreasonable to withhold acceptance of the theory. In a non-scientific
sense, some would consider such theories as "proven". Hallmarks of pseudoscience
are claims about the presence or absence of "scientific proof".
- Scientific Truth:
The simplest explanation that explains all currently known,
indisputable facts (Ockam's Razor). Note that scientific truth is not absolute truth in
the sense that scientific truth can change as more facts become known. In the scientific
process, the only absolutes are empirical data and the logical consistency
applied to it.
- Ockham's Razor (Occam, principle of parsimony, simplicity or economy):
"pluralitas non est ponenda sine necessitate"; "Entities should not be multiplied unnecessarily"
or "Multiplicity ought not be posited without necessity". The principle that if two
theories explain a phenomenon equally, the simpler theory requiring fewer assumptions and
explanatory principles is preferred and that generalizations should be based
on observed facts and not on other generalizations. One hallmark of pseudoscience is the
requirement for many assumptions and untestable explanatory principles to support the core
theories, which proponents often change when an assumption or principle is critically
refuted. Under this principle, the theory containing testable components is preferred over
the theory containing an inherently untestable component.
William of
Ockham, 1285-1349.
Scientific Hypothesis: A provisional or temporary conjecture about somethings
function or status that is based on limited or no preliminary evidence and that evidence
from further investigation will either support or refute. In this sense, a list of
differential diagnoses represents a set of hypotheses for which more evidence must be
obtained in the diagnostic process before a level of certainty is reached that is
sufficient for action. A logical problem is that although the facts derived from the test
of a hypothesis are correct, the broader underlying theory from which the hypothesis was
derived can still be wrong. Proponents of any hypothesis can defend it against contrary
evidence by ad hoc modifications of the underlying theory. Science often progresses by
researchers noting discrepant observations and pursuing their explanation with
investigations based on further hypotheses. Note that in non-scientific contexts what most
people call a "theory" is actually a hypothesis or speculation.
- Formal Hypothesis: A testable "if . . is related to
. . then . ." statement of the following form. The tentative concept, the proposed
relationship between two variables or factors, is contained in the "if"
component and the predicted outcome of a test of this hypothesis, such the experimental
manipulation of one of those variables or the observation of a natural experiment, is
contained in the "then" component. Performing the test leads to a logical
conclusion about the proposed relationship.
Scientific Experiment: The execution of procedures or methods to test a hypothesis
in a fashion that eliminates all reasonable basis for doubt as to the interpretation of
the results as either supporting or refuting the hypothesis. In the strictest sense, the
investigator controls all extraneous facts and manipulates only one or a few independent
variables to determine the effect on a dependent variable. In observational experiments,
the investigator cannot directly control manipulate variables but observes
"experiments of nature". The description of methods used must be publicly
available for rigorous scrutiny by the scientific community and must be sufficient to
enable independent repetition of the experiment. The process of medical diagnosis and
treatment of the individual patient mimics the hypothetico-deductive model of science in
the sense that the selection of the treatment is based on a hypothesis about the nature of
the illness, the application of the treatment is the execution of an experiment, and the
patients response to the treatment is the experimental outcome. However, this
process does not eliminate all reasonable basis for doubt about whether or not the outcome
supports or refutes the hypothesis and thus the underlying theory upon which the
hypothesis is based because many other factors (e.g., diagnostic error, biological
variability, self-repair) could account for the outcome. Thus, by itself an individual
case is more of an anecdote. Note that what most students experience in school
laboratories are "replications" (demonstrations) rather than experiments as the
outcome is known prior to the execution of the replication and if that result is not
obtained, the replication was executed incorrectly. Experiments are based on a testable
hypothesis and have several potential outcomes.
Pseudoscience (Quackery): The promotion of false or unsubstantiated procedures and
remedies, often with broad, non-specific claims covering a wide range of diseases, often
through anecdotes, case histories and testimonials, often with complicated pseudomedical
or pseudoscientific jargon of the authors creation, sometimes by authors with
impressive-looking degrees and titles (Dr., PhD, professor) intended to convey
credibility. The clearest indication of pseudoscience is the lack of strong, diverse,
public supporting evidence in the mainstream scientific literature. The results have not
been independently verified through the use of objective scientific methods and have not
been subjected to the scrutiny of the peer review process for publication in primary
scientific journals. Often, any cited references are books or secondary sources, with few
if any from the mainstream refereed scientific literature of recent publication. Often,
the promoters claim that they or anyone friendly to their cause who attempts to verify
their claims are persecuted by organized science or medicine because the institution does
not want competition and their results are being suppressed because of their controversial
nature or because of their alleged financial impact. The underlying hypotheses are often
at serious odds with well-established fundamental theories of related disciplines as well
as conventional medical practice. Promoters of pseudoscience often dismiss these
conventional scientific theories as invalid on the grounds that these theories cannot be
absolutely proven, which is true. Promoters of pseudoscience decry the lack of interest by
those engaged in conventional science, fail to provide substantial public evidence through
conventional publication mechanisms outside of their control that would attract interest
from more mainstream scientists, do not understand the rigorous process for developing
this evidence, and instead often resort to ad hominem attacks on their detractors. With
radical claims, the burden of generating supporting evidence is on those making the
extraordinary claims rather than the burden of denial being on more mainstream science.
The more extreme the claim, the stronger the supporting evidence must be.
Heretic: One who holds a markedly dissenting view compared to more widely held
currently accepted beliefs.
- Endoheretic:
In the scientific sense, an individual trained and working within a
discipline but who holds hypotheses that are markedly inconsistent with major components
of the theories in a discipline. Endoheretics follow the conventional process of
publishing their evidence in the refereed scientific journals of their discipline.
Examples are Galileo, Lister, an anesthesiologist who proposed the need for antisepsis
before the germ theory of disease was known, Wegner, a geologist who proposed the theory
of continental drift, and Prusner, who proposed that prions were responsible for
transmissible encephalopathies. Issac Asimov estimated that about 1 in 50 of these
hypotheses put forward by endoheretics are upheld and, when they are, a major paradigm
shift occurs in that discipline. This shift often occurs slowly as a large amount of
strong empirical evidence obtained through different means by different investigators is
required to cause a marked shift in a discipline.
- Exoheretic:
In the scientific sense, an individual who holds hypotheses that are
markedly inconsistent with the theories of a discipline and often with more fundamental
theories, often is not trained in that discipline, often works in isolation and does not
submit their evidence to public scrutiny in the conventional scientific publishing
process. They often hold a high opinion of themselves and a low opinion of scientists in
the discipline. They often claim to be persecuted by government agencies and to be
discriminated against by the conventional scientific establishment. They often claim that
this occurs because their findings will completely revolutionize a discipline and have an
adverse economic impact on its conventional members. Examples are Velikovsky, von Daniken,
and many promoters of medical quackery. Pseudo-scientists usually fall into this category.
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