What Kind of Basic Science for Clinical Medicine?

Abstract Clinical medicine involves explanatory decisions for the names, mechanisms and causes of disease, and managerial decisions for therapeutic interventions to prevent or alter disease. Although both types of decision depend on the intellectual constructions used in experiments, the scientific procedures required for managerial decisions about sick people differ from the methods used for explanatory science in the simpler materials of laboratory work. Because the scientific thrust of medicine has been directed mainly toward explanatory mechanisms, a suitable "basic science" has not yet been developed for making and evaluating managerial decisions. The challenges of the new "basic science" in clinical management include reducing observer variability, developing new systems of taxonomy, establishing criteria for diverse clinical judgments, and improving quantification for "normality," prognosis and therapy. Although language, logic, behavioral science and statistics will offer methodologic assistance, the fundamental strategies must be derived from direct clinical experience with patients.