TMD Diagnostic Decision-Making and Probability Theory. Part II

Whiplash injuries of the temporomandibular joint in motor vehicle accidents: Speculations and facts

“…Valid and objective biomedical observations on a patient's somatic (bodily, physical) status contain information that is similar to, but not necessarily superior to scientific facts pertaining to the realm of the physical world (Christensen & McKay 1995, 1996a,b). A scientific fact is established by means of physical scientific instrumentation, and it is verified through the principle of scientific mutual control, namely, testing of refutability.…”

“…In essence, one or more independent observers conclude through scientific methodology that a claimed fact is true, i.e. not false; it is not sufficient to formulate an opinion on the truth or falsity of the claimed fact: it must be demonstrated through the principle of scientific empiricism, namely physical instrumental evidence (Christensen & McKay 1995, 1996a,b).…”

“…In order to express biomedical observations through universally accepted and universally applicable measurements (quantifications), it is characteristic that virtually all valid and objective biomedical observations adhere to the empirical and basic scientific principle of interposing one or more calibrated measuring instruments (physical objects) between the observer and the object of observation. Accordingly and appropriately, an empirical and epistemological distinction appears between subjective and objective biomedical observations; objective scientific observations are made by means of calibrated measuring instruments; subjective pseudoscientific observations are made through the individual observer's body and mind without the use of calibrated measuring instruments (Christensen & McKay 1995, 1996a,b).…”

“…Experience shows that any diagnostic system that is based mainly, or solely, on the experiential phenomenon of pain is open to debate and serious criticisms that are based on human intuition, human common sense, and human biomedical sciences. A major reason for the criticism is the epistemological fact that clinical pain and numerous other subjective (psychological) human phenomena are defined by their own subjective properties: the distinction between objective (scientific) and subjective (pseudoscientific) observations disappears (Christensen & McKay 1995, 1996a,b), to the effect that ‘pain is understood to represent a subjective psychological state rather than an activity that is induced solely by noxious stimulation. It should be noted that, if the subject regards his or her experience as pain, it should be accepted as pain’ (Okeson 1995).…”

“…Scientifically and mathematically speaking (Christensen & McKay 1995, 1996a,b), the situation becomes more than tenuous when introspective self—reports (anamnestic data) on pains, solicited through mailed questionnaires and using visual analogue scales (in millimetres) to record pain intensity, are used by Steigerwald, Verne & Young (1996) as evidence of the neuroanatomy and neurophysiology of musculoskeletal pains and other subjective complaints. Despite seriously questionable study design and statistical analysis, the latter authors found that the neuroanatomic pathways and neurophysiologic mechanisms of the subjective complaints (symptoms) of headache, neck and shoulder pains, tinnitus and dizziness could be correlated with and/or derived from an inadequate and subjective description of TMJ pathology (visual observations of TMJ surfaces) and perceived levels of pain intensity (Steigerwald et al .…”