The logic of medical language - es

En este capítulo, discutiremos el lenguaje médico actual. En concreto, abordaremos el estudio de las relaciones entre las expresiones lingüísticas y el mundo al que se refieren, o al que deben describir.

La conclusión es que una vez revelada la vaguedad y ambigüedad de esta forma de lenguaje (y por tanto las consecuencias negativas que todo ello conlleva), es necesario hacerlo más preciso y completo. Queremos centrarnos en un razonamiento más matemático y riguroso porque puede ser mucho más efectivo si podemos manipularlo de la manera correcta, como veremos en este capítulo. 

 

El lenguaje médico es un lenguaje natural extendido

El lenguaje es una fuente de malentendidos y errores en medicina: en realidad, a menudo el lenguaje que usamos nos deja en problemas porque está semánticamente subdesarrollado y no está de acuerdo con las ideas científicas estándar. Para explicar mejor este concepto, que aparentemente parece fuera de lugar, debemos describir algunas características esenciales de la lógica del lenguaje que nos harán comprender mejor por qué un término como dolor orofacial puede tomar un significado diferente siguiendo una lógica clásica o formal. .

El paso de la lógica clásica a la lógica formal no implica añadir un detalle menor ya que requiere una descripción precisa. Aunque la tecnología médica y dental ha desarrollado impresionantes modelos y dispositivos en muchas disciplinas de rehabilitación odontológica, como electromiógrafos, tomografía computarizada de haz cónico, escaneo digital oral, etc., el lenguaje médico aún necesita mejoras.

En primer lugar, debemos distinguir entre lenguajes naturales (inglés, alemán, italiano, etc.) y lenguajes formales, como las matemáticas. Los naturales emergen naturalmente tanto en las comunidades sociales como en las comunidades científicas. Simultáneamente, los lenguajes formales se construyen artificialmente para su uso en disciplinas como las matemáticas, la lógica y la programación informática. Los lenguajes formales se caracterizan por una sintaxis y una semántica con reglas precisas, mientras que un lenguaje natural tiene una sintaxis bastante vaga conocida como gramática y carece de semántica explícita.

Para mantener este estudio activo y atractivo, y para evitar que degenere en un aburrido tratado de filosofía de la ciencia, consideremos un caso clínico muy explicativo. Lo trataremos usando diferentes lenguajes:

• lenguaje clásico,
• lenguaje probabilístico,
• Lógica difusa y
• Lógica del Sistema.

Caso clínico y lógica del lenguaje médico

La paciente Mary Poppins (obviamente un nombre ficticio) fue seguida y tratada durante más de 10 años por varios colegas, incluidos dentistas, médicos de familia, neurólogos y dermatólogos. Su breve historia es la siguiente:

• la mujer notó por primera vez pequeños parches de pigmentación anormal en el lado derecho de la cara a la edad de 40 años (ahora tenía 50).A su ingreso a la consulta de dermatología se le realizó una biopsia de piel, la cual fue compatible con el diagnóstico de esclerodermia localizada de la cara (morfea);se prescribieron corticoides.
• A los 44 años comenzó a tener contracciones involuntarias de los músculos maseteros y temporales derechos; las contracciones aumentaron en duración y frecuencia a lo largo de los años. El paciente se refirió a las contracciones espasmódicas como bloqueo diurno y nocturno.En su primera evaluación neurológica, la discromía era menos evidente. Aún así, su rostro era asimétrico debido a una ligera muesca en la mejilla derecha y una marcada hipertrofia de los músculos maseteros y temporales derechos.Los diagnósticos fueron variados, debido a la limitación del lenguaje médico como veremos a continuación.

El escenario clínico puede reducirse a lo siguiente: la paciente expresa en su lenguaje natural el estado psicofísico que la aqueja desde hace mucho tiempo; el odontólogo, después de haberle realizado una serie de pruebas como la anamnesis, una estratigrafía y un TAC de la ATM (Figuras 1, 2 y 3), concluye con un diagnóstico de 'Trastornos Temporomandibulares', a los que denominamos 'TMD's';el neurólogo permanece en cambio en un diagnóstico de patología neuromotora orgánica del tipo 'Dolor orofacial neuropático' (nOP), excluyendo el componente TTM, o no considera la causa principal. Para no simpatizar ni con el dentista ni con el neurólogo en este contexto, consideraremos al paciente que sufre de 'TMDs/nOP'; para que nadie pelee.

 

«¿Pero quién tendrá razón?»

Obviamente estamos frente a una serie de temas que merecen una adecuada discusión porque se refieren al diagnóstico clínico.

A diferencia de los lenguajes formales de las matemáticas, la lógica y la programación informática (que son sistemas artificiales de signos con reglas precisas de sintaxis y semántica), la mayoría de los lenguajes científicos se desarrollan como una simple expansión del lenguaje natural con una combinación de algunos términos técnicos. El lenguaje médico pertenece a esta categoría intermedia. Surge del lenguaje natural y cotidiano añadiendo términos como 'dolor neuropático', 'Trastornos Temporomandibulares', 'desmielinización', 'alodinia', etc. Es por ello que no tiene una sintaxis específica y semántica más allá de la que toma del lenguaje natural. . Por ejemplo, consideremos el término 'enfermedad' que se refiere a la paciente Mary Poppins: este es un término que indica el concepto fundamental de la medicina, la enfermedad en la base de la nosología y la investigación y práctica clínica. Se espera que sea un término técnico bien definido, pero sigue siendo un término indefinido.

Nadie sabe lo que significa con precisión y, aparte de algunos filósofos de la medicina, nadie está interesado en su significado exacto. Por ejemplo, ¿la 'enfermedad' se refiere al sujeto/paciente o al Sistema (como organismo vivo)? Y en consecuencia: ¿puede un paciente que no está enfermo a tiempo $t_{n}$ convivir con un sistema ya en estado de daño estructural en el tiempo$t_{i,-1}$?

El término languidece sin semántica alguna como si fuera irrelevante o gratuito y sus derivados comparten con él la misma oscuridad semántica.

En breve,

• ¿La paciente Mary Poppins está enferma o el sistema de masticación está dañado?
• ¿Es más bien una enfermedad del 'Sistema' considerando el Sistema masticatorio en su totalidad que consta de subconjuntos tales como receptores, tejido nervioso periférico y central, huesos maxilares, dientes, lengua, piel, etc.?
• ¿O es una enfermedad de 'órgano' que afecta en este caso específico a la articulación temporomandibular (ATM)?

Estas breves notas demuestran cómo las inexactitudes y peculiaridades del lenguaje natural entran en la medicina a través de su forma sintáctica y semánticamente subdesarrollada. Algunas de estas peculiaridades deberíamos tratarlas con ejemplos clínicos concretos.

Enfoque clínico

(pasa el cursor sobre las imágenes)

• 

  Figure 1:Paciente que informa 'dolor orofacial' en la cara hemilateral derecha

• 

  Figure 2: Estratigrafía de la ATM del paciente que muestra signos de aplanamiento condilar y osteofito

• 

  Figure 3: Tomografía computarizada de la ATM que confirma la estratigrafía de la figura 2

¿Qué significa un término médico?

Preguntémonos qué significa "sentido".

El Diccionario de Cambridge dice que "El significado de algo es lo que expresa o representa".Por simple que parezca, la noción de "significado" es bastante genérica y vaga; todavía no existe una respuesta comúnmente aceptada a la pregunta "¿qué significa 'significado'?" Se han propuesto teorías controvertidas del significado, y cada una tiene sus ventajas y desventajas..

Tradicionalmente, un término se muestra como una etiqueta lingüística que significa un objeto en un mundo, concreto o abstracto. Se cree que el término se encuentra en el idioma como representante de ese objeto, p. 'manzana' para la famosa fruta. Este término 'manzana' tendrá el mismo significado para el niño americano, el adulto europeo o el anciano chino, mientras que el significado 'Dolor orofacial' tendrá una intención para el neurólogo, otra para el dentista, y su propia esencia la desafortunada María. Poppins.

Tales expresiones no derivan su significado de representar algo en el mundo exterior, sino de cómo se relacionan con otros términos dentro del mundo o contexto de uno.

El significado del dolor para Mary Poppins es sobre lo que puede significar para ella, para su conciencia, y no sobre el mundo exterior: en realidad, pedirle al paciente que le atribuya un valor numérico a su dolor, digamos de 0 a 10, no tiene sentido. , no tiene significado, porque no hay ninguna referencia normalizadora interna al mundo o contexto de uno.
Lo mismo es cierto para el neurólogo que le dará sentido al término 'dolor en la mitad derecha de la cara' únicamente en su contexto basado en sinapsis, axones, canales iónicos, potenciales de acción, neuropéptidos, etc.
El odontólogo hará lo mismo, en base a su contexto compuesto principalmente por dientes, articulación temporomandibular, músculos masticatorios, oclusión, etc.

No se deben descuidar los conceptos cuando se trata de 'diagnósticos diferenciales', porque podrían ser fuentes de errores clínicos. Por esta razón, deberíamos reflexionar sobre la filosofía moderna del 'Sentido', que comenzó con Gottlob Frege,como un compuesto de "extensión" e "intención" de un término que expresa un concepto.

El concepto tiene su extensión (incluye a todos los seres con la misma cualidad) y 'comprensión' (un complejo de marcadores referidos a la idea). Por ejemplo, el concepto de dolor se refiere a muchos seres humanos, pero es más genérico (gran extensión, pero poca comprensión). Si consideramos el dolor en pacientes que reciben, por ejemplo, implantes dentales, en pacientes con pulpitis dental inflamatoria en curso y pacientes con dolor neuropático (odontalgia atípica) tendremos:

1. Aumentos del umbral de percepción mecánica y del umbral de percepción sensorial relacionados con la activación de las fibras C.
2. Anomalías somatosensoriales como alodinia, percepción mecánica reducida y alteración de la modulación del dolor en pacientes con odontalgia atípica.
3. Sin alteración somatosensorial tras la inserción del implante, aunque los pacientes refieren dolor leve en la región tratada.

Sobre el 'dolor' en general podemos decir que tiene una amplia extensión y una comprensión mínima, pero si consideramos el tipo de dolor mencionado anteriormente, por ejemplo en pacientes que reciben implantes dentales, en pacientes con pulpitis dental inflamatoria en curso y en pacientes con dolor neuropático (odontalgia atípica), se hace evidente que cuanto mayor es la comprensión, menor es la extensión.

La intensión de un concepto, en cambio, es un conjunto de aspectos que lo distinguen de los demás. Estas son las características que diferencian el término genérico de "dolor", que al articular la intensión de un concepto reduce automáticamente su extensión. Obviamente, sin embargo, varias escalas de generalidad pueden descender de un concepto dependiendo de qué aspecto de su intención se articule. Es por ello que conceptualmente podríamos distinguir el dolor en la ATM del dolor neuropático.

---

Podemos decir convenientemente, por lo tanto, que el significado de un término $\mathrm {S}$ con respecto a un idioma en particular $\mathrm {l}$ es una pareja ordenada, formada por extensión e intensión, en un mundo que ahora llamaremos “contexto”.

Precisamente en referencia al contexto debemos señalar que:

1. En el 'contexto' odontológico, el término dolor en la mitad derecha de la cara representa una extensión relativamente grande (por lo que puede clasificarse en un área que incluye a los 'TMD') y una intensión compuesta por una serie de características clínicas quizás apoyadas por una serie de investigaciones radiológicas instrumentales, EMG, axiográficas, etc.
2. En el 'contexto' neurológico, sin embargo, el término dolor en la mitad derecha de la cara representa una extensión 'nOP' relativamente amplia y una intensión compuesta por una serie de características clínicas, tal vez respaldadas por una serie de investigaciones radiológicas instrumentales, EMG, somatosensoriales evocadas. potenciales, etc

Este breve pero esencial argumento nos permite constatar cómo la expresión lingüística de un lenguaje médico es vulnerable por una serie de razones; entre estos, tenga en cuenta la incompletitud semántica, así como también cómo un significado puede ser tan diferente en diferentes contextos que los términos 'nOP' o 'TMD' se vuelven ambiguos con estas premisass.

Ambiguity and Vagueness

As said, beyond the language used, the meaning of a medical term also depends on the contexts from which it originates, and this can generate ‘ambiguity’ or ‘polysemy’ of the terms. A term is called ambiguous or polysemic if it has more than one meaning. Ambiguity and vagueness have been the subject of considerable attention in linguistics and philosophy; but despite the significant detrimental effect of ambiguity and vagueness on adherence to and implementation of the Clinical Pratice Guideline (CPG), these concepts have not been explored and differentiated yet in a medical context.

Doctors' interpretation of vague terms varies greatly, leading to a reduced grip and q greater practice variation from CPGs. Ambiguity is classified into syntactic, semantic and pragmatic types.

As previously described, the meaning of a simple linguistic expression referred to by Mary Poppins has at least three different meanings in three different contexts. The ambiguity and vagueness in the linguistic expression behind the term ‘orofacial pain’, which at the same time could be a source of diagnostic errors, mainly concerns the inefficiency of the medical language logic in decrypting the machine message that the System sends in real time to the exterior.

Let's spend a minute trying to describe this interesting topic of encrypted machine language from which the following chapters will be articulated.

Orofacial pain does not have a meaning in its most genuine lexical form, but rather in what it means in the context in which it exists: a whole series of domains referred to and generated by it such as clinical signs, related symptoms and interactions with other neuromotor, trigeminal, dental districts, etc. This machine language does not correspond to verbal language, but to an encrypted language built on its own alphabet, that generates the message to be converted into verbal (natural) language. Now the problem shifts to the language logic used to decrypt the code. In order to describe this concept in an understandable way, let’s contemplate a series of examples.

We are supposing that the unfortunate Mary Poppins is suffering from ‘orofacial pain’, and she is representing the following to the healthcare professionals to whom she relates:

«Doc, 10 years ago I started with a widespread discomfort in the jaw, including episodes of bruxism; these worsened so much that I was accusing ‘diffuse facial pain’, in particular in the area of the right ‘TMJ’ with noises in the movements mandibular.
During this period, ‘vesicular lesions’ formed on my skin, which were more evident in the right half of my face.
In this period, however, the pain became more intense and intermittent»

The healthcare worker, who may be a dermatologist, a dentist or a neurologist, picks up some verbal messages in Mary Poppins’ dialogue, such as ‘diffuse facial pain’ or ‘TMJ’ or ‘vescicular lesion’, and establishes a series of hypothetical diagnostic conclusions that have nothing to do with the encrypted language.

Here, however, we should abandon a little the acquired patterns and opinions to better follow the concept of ‘encrypted language’. Let's suppose, therefore, that the System is generating and sending the following encrypted message, for instance: Ephaptic.

Now, what has ‘Ephaptic’ to do with _nOP or TMDs?

Nothing and everything, as we will better verify at the end of the chapters about the logic of medical language; but by now we will dedicate some time to the concepts of encryption and decryption. We have perhaps heard about them in spy movies or in information security, but they are important in medicine too, you'll see.

Encryption

Let us continue with our example:

Let us take a common encryption and decryption platform. In the following example we will report the results of an Italian platform but we can choose any platform because the results conceptually do not change:

You type your message in plain text, the machine converts it into something unreadable, but anyone knowing the "code" will be able to understand it.

Let us suppose, then, that the same happens when the brain sends a message in its own machine language, made up of wave trains, packets of ionic fields and so on; and that carries a message with it to decrypt the ‘Ephaptic’ code.

This message from the Central Nervous System must first be transduced into verbal language, to allow the patient to give meaning to the linguistic expression and the doctor to interpret the verbal message. In this way, however, the machine message is polluted by the linguistic expression: both by the patient, who is unable to convert the encrypted message with the exact meaning (epistemic vagueness), and by the doctor, because he/she is conditioned by the specific context of his/her specialization.

The patient, actually, by reporting a symptomatology of orofacial pain in the region of the temporoandibular joint, virtually combines the set of extension and intention into a diagnostic concept that allows the dentist to formulate the diagnosis of orofacial pain from temporomandibular disorders. (TMDs).

Very often the message remains encrypted at least until the system is damaged to such an extent that clinical signs and symptoms emerge so striking that, obviously, they facilitate the diagnosis.

Understanding how the encryption works is quite simple (go to decryption platform chooses and to try it out):

1. choose an encryption key among those selected;
2. type a word;
3. get a code corresponding to the chosen key and the typed word.

For example, if we insert the word ‘Ephaptic’ in the platform encryption system, we will have an encrypted code in the three different contexts (patient, dentist and neurologist) which correspond to the three different algorithmic keys indicated by the program, for instance: the A key corresponds to the patient's algorithm, the B key to the dental context and the C key to the neurological context.

In the case of the patient, for example, writing Ephaptic and using the A key, the "machine" will give us back a code like

$133755457655037A$

The key can be defined as "Real context".

 

«Why do you say that the patient's "key" is defined as the REAL one?» (difficult answer, but please observe the Gate Control phenomenon and you will understand)

First of all: Only the patient is unconsciously aware of the disease that afflicts his own system, but he does not have the ability to transduce the signal from the machine language to the verbal language. The same procedure occurs in 'Systems Control Theory', in which a dynamic control procedure called ‘State Observer’ is designed to estimate the state of the system from output measurements. Matter of fact, in the control theory, observability is a measure of how much the internal state of a system can be deduced from the knowledge of its external outputs. While in the case of a biological system a ‘Stochastic Observability’ of linear dynamic systemsis preferred, the Gramian matrices are used for the stochastic observability of nonlinear systems.

This would already be enough to bring now our attention on an extraordinarily explanatory phenomenon called Gate Control. If a child gets hit in the leg while playing soccer, in addition to crying, the first thing he does is to rub extensively the painful area so that the pain decreases. The child does not know the ‘Gate Control’, but unconsciously activates an action that, by stimulating the tactile receptors, closes the gate at the entrance of the nociceptive input of the C fibres, consequently decreasing the pain; the phenomenon was discovered only in 1965 by Ronald Melzack and Patrick Wall.

As much as in computers, encryption-decryption also takes place in biology. In fact, in a recent research the authors examined the influence of molecular mechanisms of the ‘long-term potentiation’ (LTP) phenomenon in the hippocampus on the functional importance of synaptic plasticity for storage of information and the development of neuronal connectivity. It is not yet clear if the activity modifies the strength of the single synapses in a digital (01, all or nothing) or analog (graduated) way. In the study it emerges that individual synapses appear to have an 'all or nothing' enhancement, indicative of highly cooperative processes, but different thresholds for undergoing enhancement. These findings raise the possibility that some forms of synaptic memory may be digitally stored in the brain.

Decryption

Now, assuming that the machine language and the assembler code are well structured, we insert the encrypted message from the Mary Poppins System in the 'Mouth of Truth‘:

$133755457655037A$

Let's pretend that we are Martians in possession of the right key (algorithm or context) the A key that corresponds to the 'Real Context'. We would be able to perfectly decrypt the message, as you can verify by entering the code in the appropriate window:

«Ephaptic»

But, luckily or not, we are not Martians, so we will use, contextually to the information acquired from the social and scientific context, the dental key that correspond to B key, with the consequent decryption of the message into:

«5GoI49E5!»

Using the C key that corresponds to the neurological context, the decryption of the message would be:

«26k81n_g+»

These are extraordinarily interesting elements of language logic, and please note that the encrypted message of the real context ‘meaning’ of the ‘disease’, the A key, is totally different from the one encrypted through the B keys and the C key: they are constructed in conventionally different contexts, while there is only one reality and this indicates a hypothetical diagnostic error.

This means that medical language logics mainly built on an extension of verbal language, are not very efficient in being quick and detailed in diagnostics, especially the differential one. This is because the distortion due to the ambiguity and semantic vagueness of the linguistic expression, called ‘vagueness epistemic’ or ‘epistemic uncertainty’, or better ‘uncertain knowledge’, forcibly directs the diagnosis towards the specialist reference context and not on the exact and real one.

 

«Why, then, are we relatively successful in diagnostics?» (An entire separate encyclopedia would be needed to answer to this question, but without going too far, let's try to discuss the reasons.)

Basic diagnostic intuition is a quick, non-analytical and unconscious way of reasoning. A small body of evidence indicates the ubiquity of intuition and its usefulness in generating diagnostic hypotheses and ascertaining the severity of the disease. Little is known about how experienced doctors understand this phenomenon, and about how they work with it in clinical practice. Most reports of the physician’s diagnostic intuition have linked this phenomenon to non-analytical reasoning and have emphasized the importance of experience in developing a reliable sense of intuition that can be used to effectively engage analytical reasoning in order to evaluate the clinical evidence. In a recent study, the authors conclude that clinicians perceive clinical intuition as useful for correcting and advancing diagnoses of both common and rare conditionsIt should also be noted that the Biological System sends a uniquely integrated encrypted message to the outside, in the sense that each piece of code will have a precise meaning when individually taken, while if combined with all the others it will generate the complete code corresponding to the real message, that is to "Ephaptic”.

In short, an instrumental report (or a series of instrumental reports) is not enough to decrypt the machine message in an exact way corresponding to reality. If we expect the message to be decrypted from 2/3 of the code, which perhaps corresponds to a series of laboratory investigations, we would get the following decryption result:

«Ef+£2»

This outcome comes from the deletion of the last two elements of the originating code: $13375545765503$ resulting from $133755457655037A$. So, part of the code is decrypted (Ef) while the rest remains encrypted and the conclusion speaks for itself: it is not enough to identify a series of specific tests, yet it is necessary to know how to tie them together in a specific way in order to complete the real concept and build the diagnosis.

Therefore, there is a need for:

 

«A System Logic that integrates the sequence of the machine language code» (true! we'll get there with a little patience)

Final Considerations

The logic of language is by no means a topic for philosophers and pedagogues; but it substantially concerns a fundamental aspect of medicine that is Diagnosis. Note that the International Classification of Diseases, 9th Revision (ICD-9), has 6,969 disease codes, while there are 12,420 in ICD-10 (OMS 2013). Based on the results of large series of autopsies, Leape, Berwick and Bates (2002a) estimated that diagnostic errors caused 40,000 to 80,000 deaths annually. Additionally, in a recent survey of over 6,000 doctors, 96% believed that diagnostic errors were preventable.

Charles Sanders Peirce (1839–1914) was a logician and practicing scientist; he gradually developed a triadic account of the logic of inquiry. He also distinguishes between three forms of argumentation, types of inference and research methods that are involved in scientific inquiry, namely:

1. Abduction or the generation of hypotheses
2. Deduction or drawing of consequences from hypotheses; and
3. Induction or hypothesis testing.

In the final part of the study conducted by Donald E Stanley and Daniel G Campos, the Peircean logic is considered as an aid to guaranteeing the effectiveness of the diagnostic passage from populations to individuals. A diagnosis focuses on the individual signs and symptoms of a disease. This manifestation cannot be extrapolated from the general population, except for a very broad experiential sense, and it is this sense of experience that provides clinical insight, strengthens the instinct to interpret perceptions, and grounds the competence that allows us to act. We acquire basic knowledge and validate experience in order to transfer our observations into the diagnosis.

In another recent study, author Pat Croskerry proposes the so-called "Adaptive Expertise in Medical Decision Making", in which a more effective clinical decision could be achieved through adaptive reasoning, leading to advanced levels of competence and mastery.

Adaptive competencies can be obtained by emphasizing the additional features of the reasoning process:

1. Be aware of the inhibitors and facilitators of rationality (Specialists are unwittingly projected towards their own scientific and clinical context).
2. Pursue the standards of critical thinking. (In the specialist, self-referentiality is supported and criticisms from other scientific disciplines or from other medical specialists are hardly accepted).
3. Develop a global awareness of cognitive and affective biases and learn how to mitigate them. Use argument that reinforces point 1.
4. Develop a similar depth and understanding of logic and its errors by involving metacognitive processes such as reflection and awareness. Topic is already mentioned in the first chapter ‘Introduction’.

In this context, extraordinarily interesting factors emerge that lead us to a synthesis of all what has been presented in this chapter. It is true that the arguments of abduction, deduction and induction streamline the diagnostic process but we still speak of arguments based on a clinical semeiotics, that is on the symptom and/or clinical sign. Even the adaptive experience mentioned by Pat Croskerry is refined and implemented on the diagnosis and on the errors generated by a clinical semeiotics.

Therefore, it is necessary to specify that semeiotics and/or the specific value of clinical analysis are not being criticized because these procedures have been extraordinarily innovative in the diagnostics of all time. In the age in which we live, however, it will be due to the change in human life expectancy or the social acceleration that we are experiencing, ‘time’ has become a conditioning factor, not intended as the passing of minutes but essentially as bearer of information.

In this sense, the type of medical language described above, based on the symptom and on the clinical sign, is unable to anticipate the disease, not because there is no know-how, technology, innovation, etc., but because the right value is not given to the information carried over time

This is not the responsibility of the health worker, nor of the Health Service and nor of the political-industrial class because each of these actors does what it can do with the resources and preparation of the socio-epochal context in which it lives.

The problem, on the other hand, lies in the mindset of mankind that prefers a deterministic reality to a stochastic one. We will discuss these topics in detail.

In the following chapters, all dealing with logic, we will try to shift the attention from the symptom and clinical sign to the encrypted machine language: for the latter, the arguments of the Donald E Stanley-Daniel G Campos duo and Pat Croskerry are welcome, but are to be translated into topic ‘time’ (anticipation of the symptom) and into the message (assembler and non-verbal machine language). Obviously, this does not preclude the validity of the clinical history (semeiotics), essentially built on a verbal language rooted in medical reality.

We are aware that our Linux Sapiens is perplexed and wondering:

 

«... could the logic of Classical language help us to solve the poor Mary Poppins' dilemma?» (You will see that much of medical thinking is based on the logic of Classical language but there are limits)

Bibliography & references

Masticationpedia is a charity, a not-for-profit organization operating in dentistry medical research,
particularly focusing on the field of the neurophysiology of the masticatory system
 

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