». Sacrifier-la-généralisabilité, I. Kleinbaum, G. David, L. L. Kupper, H. Et-morgenstern et al., Voir aussi la critique qu'en font Rothman et Greenland dans Rothman, Lifetime Learning Publications, pp.115-134, 0199.

S. Campbell, une nouvelle manière de raisonner. La logique de la médecine, c'est précisément le titre d'un ouvrage d'Edmond Murphy, qui parait en 1976, et qu'il convient à présent d'étudier. 5.1.2 Edmond Murphy et le projet d'une logique de la médecine : Tout d'abord, il convient de souligner que le titre qu'Edmond Murphy 42 donne à son ouvrage, The Logic of Medicine (en français : La logique de la médecine), doit être pris en son sens le plus littéral, p.76, 1967.

, En effet, l'objectif de Murphy est énoncé dès son introduction

«. Objectif, Ces données, ou ces « faits », sont supposées être vraies, mais cette vérité, selon Murphy, n'est que provisoire 43 et c'est pourquoi il est plus important de s'intéresser aux « règles de la preuve, « cet ouvrage porte sur les idées [« this book is about ideas, 1976.

, et dont la négligence, aussi bien dans le cursus médical que par les médecins eux-mêmes, est « irresponsable » (Murphy, 1976, p. ix). C'est pourquoi Murphy entend dans son ouvrage, destiné aux « étudiants en première année de médecine » 44 leur permettre de « cultiver un sens commun alerte, 1976.

, Murphy part en effet d'un constat similaire à celui de Feinstein concernant la

E. Sur and . Murphy, Pour notre sujet, il est important de noter que Murphy est d'abord un médecin, né au Pays de Galles, formé à l'Université de Belfast en Irlande du Nord, où il obtient son doctorat en médecine en 1952, avant de s'exiler aux Etats-Unis en 1956, plus précisément à la Johns Hopkins University School of Medicine. C'est à l'université et à l'hôpital de Johns Hopkins qu'il passe l'essentiel de sa carrière d'enseignant et de médecin, notamment dans la Division de génétique médicale, et à la Johns Hopkins School of Public Health qu'il obtient son doctorat en biostatistiques en 1964. En plus de son intérêt pour les aspects épistémologiques et éthiques de la médecine, Murphy s'est beaucoup intéressé au conseil génétique, qu'il a pratiqué et dont il a défini les principes dans un ouvrage, écrit en collaboration avec un de ses anciens étudiants, Gary Chase, paru en 1975 et intitulé : Principles of Genetic Counseling. Il a été notamment un des premiers, La source la plus complète d'informations biographiques et bibliographiques, 2017.

P. S. Harper and . Short, Oxford monographs on medical genetics, vol.557, 2008.

, Il ajoute, plus loin : « Ce serait une erreur pour le lecteur de considérer que ce qui compte ici ce sont les faits, « Biological mechanisms are complex and what purports to be a fact has a « short half-life, 1976.

, « medical students in their first year, p.p. x, 1976.

«. Le-statisticien and T. Murphy,

A. Tony and . Hill, qu'il a rencontré vers 1966-1967, et dont la « prose et la présence » l'ont « captivé, p.26, 2015.

J. M. Last, A dictionary of epidemiology, p.13, 1988.

J. M. Last and . Et, A dictionary of epidemiology, 4ème édition, International Epidemiological Association, p.14, 2001.

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, où il souligne à quel point l'épidémiologie traditionnelle est non-pertinente (« irrelevant ») et vue avec « dédain, et Last, p.27, 1969.

D. L. Sackett, American Journal of Epidemiology, vol.89, pp.125-128, 1969.

. Bermudes-(feinstein, et qui renvoie à la « détection, pp.38-39, 1979.

, Ce sont Ibrahim et Spitzer qui soulignent

A. R. Feinstein and C. K. Wells, Cigarette smoking and lung cancer: the problems of "detection bias" in epidemiologic rates of disease, Transactions of the Association of American Physicians, vol.87, pp.180-185, 1974.

, variable d'exposition avec les effets d'autres variables (confondantes) », mélange qui va « produire une distorsion de la mesure de l'effet ou de l'association

;. Spitzer, . Ibrahim, and . Spitzer, qui constituent les facteurs de confusion les plus communs, mais dont la liste peut s'avérer très longue. Ibrahim et Spitzer citent alors les outils traditionnels comme l'appariement (« matching ») ou plus modernes comme la « stratification » ou « l'analyse multi-variée » pour « isoler l, p.142, 1979.

. Ainsi, . Murphy, . Sackett, . Kleinbaum, . Kupper et al., Ibrahim et Spitzer préfèrent quant à eux une taxinomie que nous pourrions, par opposition, qualifier de synchronique. Or, c'est bien cette taxinomie en trois classes qui sera retenue par les épidémiologistes, plutôt que celle proposée par Murphy ou par Sackett : par exemple, Kleinbaum, Kupper, et Morgenstern dans leur ouvrage intitulé Epidemiologic research. Principles and quantitative methods 80 , publié en 1982, soit quatre ans après la tenue de cette conférence, reprennent la classification en biais de sélection, biais d'information et biais de confusion dans le chapitre 10, consacré à des considérations générales sur la « validité, que nous avons qualifiée de diachronique, qui renvoie aux différentes étapes de l'inférence, pp.183-193, 1982.

D. Sackett, Sackett, 1979) qui y figure, ce qui montre que les auteurs ont bien choisi cette classification en trois catégories, plutôt que l'approche de Sackett. Cette classification se retrouve aussi dans l'ouvrage de Rothman et Greenland, intitulé Modern Epidemiology 81 , dont la deuxième édition parait en 1998. Dès lors, la question qui se pose est de savoir si le concept épidémiologique de biais

D. Spitzer and . Kleinbaum, Kupper et Morgenstern, ou encore de Rothman et Greenland) est bien le même que le concept médical de biais

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, En effet, si l'on prend par exemple le concept de biais chez Sackett, la notion d'erreur n'apparait pas et est remplacée par celle beaucoup plus vague de « processus, 1979.

, Mais comment cette systématicité peut-elle être assurée alors même qu'il n'y a pas de rapport entre les différents biais ? Autrement dit, comment un biais de rhétorique, qui ne peut être d'ailleurs considéré comme une erreur, peut-il être ou devenir systématique ? La question n'a tout simplement pas de sens. La contradiction est surmontée si l'on se place d'un point de vue plus général : le point central en effet dans la présentation que fait Sackett des biais se situe dans les différentes étapes de l'inférence qu'il distingue, chaque étape étant potentiellement une source de biais, et plus précisément dans la relation des étapes entre eux. En effet, à la fin de la septième et dernière étape (le biais de publication) Sackett indique entre crochets : « and back to (1) », c'est-à-dire retour à la première étape qui est celle où le chercheur s'informe de l, vol.95

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