The Controversy Over the Application of Parsimony Principle in Medical Diagnosis
Main Article Content
Abstract
The principle of parsimony in relation to medical diagnosis states that a physician should always choose simpler diagnostic hypotheses. This principle is the subject of analysis not only by philosophers of science but also by clinicians. The article will demonstrate that the significance of this principle is not based on its a priori justification (the perspective of philosophers) but on the fact that it can serve as a starting point for a better understanding of the process of generating new hypotheses in medical diagnosis. It will be shown that in this process, the diagnostician is guided by three main rules of data management: the principle of errors avoidance (PEA), the principle of epistemic benefits increase (EBI) and the disease prevalence condition (DPC). These rules have different roles in diagnostic decisions in various epistemic contexts.
Article Details
Issue
Section

This work is licensed under a Creative Commons Attribution 4.0 International License.
By submitting his/her work to the Editorial Board, the author accepts, upon having his/her text recommended for publication, that Diametros applies the Attribution 4.0 International (CC BY 4.0) license to the works we publish. Under this license, authors agree to make articles legally available for reuse, without permission or fees. Anyone may read, download, copy, print, distribute or reuse these articles without asking prior permission from the publisher or the author, as long as the author and original source are properly cited. The author holds the copyright without any other restrictions. Full information about CC-BY: https://creativecommons.org/licenses/by/4.0/legalcode.
How to Cite
References
Ambardekar, A. V. (2019). When you hear hoof beats, think of the treatable zebras. JACC Heart Failure, 7(11), 967–969. https://doi.org/10.1016/j.jchf.2019.08.002
Boeing A., Burger, H. (2018). If you hear hoof beats, think horses, not zebras. Thorac Cardiovascular Surgery, 07(01), e. 35. https://doi.org/10.1055/s-0038-1660808
Cartwright, N. (2010). What are randomised controlled trials good for? Philosophical Studies, 147, 59–70. https://doi.org/10.1007/s11098-009-9450-2
Cartwright, N., Munro, E. (2010). The limitations of randomized controlled trials in predicting effectiveness. Journal of Evaluation in Clinical Practice, 16(2), 260–266. https://doi.org/10.1111/j.1365-2753.2010.01382.x
Hilliard, A. A., Weinberger, S. E., Tierney, L. M., Jr, Midthun, D. E., Saint, S. (2004). Clinical problem-solving. Occam’s razor versus Saint’s triad. The New England Journal of Medicine, 350(6), 599–603. https://doi.org/10.1056/NEJMcps031794
Jędrychowski, W. (2002). Podstawy epidemiologii. Wydawnictwo Uniwersytetu Jagiellońskiego.
Jolobe, O. (2016). Caveats to the application of diagnostic parsimony. QJM: An International Journal of Medicine, 109(2), 143. https://doi.org/10.1093/qjmed/hcv157
Kopatic, M. C., Borek, H. A. (2021). The perils of diagnostic parsimony. Academic Emergency Medicine, 28(1), 148–149. https://doi.org/10.1111/acem.14060
Lakshman, A., Nampoothiri, R. V., Law, A. D., Malhotra, P., Varma, S. C. (2016). Hypereosinophilia in a young patient: Occam’s razor or Hickam's dictum? Indian Journal of Hematology and Blood Transfusion, 32(1), 340–343. https://doi.org/10.1007/s12288-014-0487-9
Russo, F., Williamson, J. (2007). Interpreting causality in the health sciences. International Studies in the Philosophy of Science, 21(2), 157–170. https://doi.org/10.1080/02698590701498084
Russo, F., Williamson J. (2011). Epistemic causality and Evidence-Based Medicine. History and Philosophy of the Life Sciences, 33(4), 563–581.
Rzepiński, T. (2023). Subjectivity of pre-test probability value: controversies over the use of Bayes’ Theorem in medical diagnosis. Theoretical Medicine and Bioethics, 44, 301–324. https://doi.org/10.1007/s11017-023-09614-6
Shattner, A. (2016). Caveats to the application of diagnostic parsimony – reply. QJM: An International Journal of Medicine, 109(2), 144. https://doi.org/10.1093/qjmed/hcv161
Smith, S., Paauw, D. (2000). When you hear hoof beats: four principles for separating zebras from horses. The Journal of American Board of Family Practice, 13(6), 424–429. https://doi.org/10.3122/15572625-13-6-424
Sober, E. (1991). Let’s razor Ockham’s razor. W: D. Knowles (red.), Explanation and its limits (s. 73–94). Cambridge University Press. https://doi.org/10.1017/CBO9780511599705.006
Sober, E. (2015). Ockham’s razor. A user’s manual. Cambridge University Press.
Sox, H. C., Higgins M. C., Owens D. K. (2013). Medical decision making. Wiley-Blackwell.
Stanley, D. (2019). The logic of medical diagnosis: generating and selecting hypotheses. Topoi, 38, 437–446. https://doi.org/10.1007/s11245-017-9516-2
Stanley, D., Campos D. (2013). The logic of medical diagnosis. Perspectives in Biology and Medicine, 56(2), 300–315. https://doi.org/10.1353/pbm.2013.0019
Stegenga, J. (2014). Down with the hierarchies. Topoi, 33, 313–322. https://doi.org/10.1007/s11245-013-9189-4
Tversky, A., Kahneman, D. (1982). Judgments of and by representativeness. W: D. Kahneman, P. Slovic, A. Tversky (red.) Judgment under uncertainty: heuristics and biases (s. 84–100). Cambridge University Press.
Venegas, C., Svenningsen, S., Kjarsgaard, M., Tarnopolsky, M., Anderson, K., Levesque, S., Raby, B. A., Parraga, G., Cox, G., Nair, P. (2020). Lessons of the month: A breathless severe asthmatic in the genomic era: Occam’s razor or Hickam’s dictum?. Clinical medicine, 20(6), e264–e266. https://doi.org/10.7861/clinmed.2020-0661
Wardrop, D. (2008). Ockham’s razor: sharpen or re-sheathe? Journal of the Royal Society of Medicine, 101(2), 50–51. https://doi.org/10.1258/jrsm.2007.070416
Williamson, J. (2006). Causal pluralism versus epistemic causality. Philosophica, 77(1), 69–96. https://doi.org/10.21825/philosophica.82198
Willis, B. H., Beebee, H., Lasserson, D. S. (2013). Philosophy of science and diagnostic process. Family Practice, 30(5), 501–505. https://doi.org/10.1093/fampra/cmt031
Worrall, J. (2002). What evidence in Evidence-Based Medicine? Philosophy of Science, 69(S3), 316–330. https://doi.org/10.1086/341855
Wulff, H., Gøetzsche, P. (2005). Racjonalna diagnoza i leczenie. Wprowadzenie do medycyny wiarygodnej czyli Evidence-Based Medicine (Z. Szawarski, tłum.). AKTIS.