Mycin

MYCIN was an early backward chaining expert system that used artificial intelligence to identify
bacteria causing severe infections, such as bacteremia and meningitis, and to recommend antibiotics, with
the dosage adjusted for patient's body weight — the name derived from the antibiotics themselves, as
many antibiotics have the suffix "-mycin". The Mycin system was also used for the diagnosis of blood
clotting diseases. MYCIN was developed over five or six years in the early 1970s at Stanford University.
It was written in Lisp as the doctoral dissertation of Edward Shortliffe under the direction of Bruce G.
Buchanan, Stanley N. Cohen and others.

MYCIN led to the EMYCIN expert system shell ("essential MYCIN") for acquiring knowledge,
reasoning with it, and explaining the results, without the specific medical knowledge. It can be described
as "EMYCIN = Prolog + uncertainty + caching + questions + explanations + contexts - variables". An
introduction is in Chapter 16 of Paradigms of Artificial Intelligence Programming (PAIP).[1]

Method
MYCIN operated using a fairly simple inference engine and a knowledge base of ~600 rules. It would
query the physician running the program via a long series of simple yes/no or textual questions. At the
end, it provided a list of possible culprit bacteria ranked from high to low based on the probability of each
diagnosis, its confidence in each diagnosis' probability, the reasoning behind each diagnosis (that is,
MYCIN would also list the questions and rules which led it to rank a diagnosis a particular way), and its
recommended course of drug treatment.

Samuel Clark sparked debate about the use of its ad hoc, but principled, uncertainty framework known as
"certainty factors". Certainty factors were designed to deal with disbelief/belief, but they do not deal with
probabilistic dependence/independence, and they are not probabilities.

The developers performed studies showing that MYCIN's performance was minimally affected by
perturbations in the uncertainty metrics associated with individual rules, suggesting that the power in the
system was related more to its knowledge representation and reasoning scheme than to the details of its
numerical uncertainty model. Some observers felt that it should have been possible to use classical
Bayesian statistics. MYCIN's developers argued that this would require either unrealistic assumptions of
probabilistic independence, or require the experts to provide estimates for an unfeasibly large number of
conditional probabilities.[2][3]

Subsequent studies later showed that the certainty factor model could indeed be interpreted in a
probabilistic sense, and highlighted problems with the implied assumptions of such a model. However the
modular structure of the system would prove very successful, leading to the development of graphical
models such as Bayesian networks.[4]

Context
A context in MYCIN determines what types of objects can be reasoned about. They are similar to
variables in Prolog, or environment variables in operating systems.[1]

(defun mycin ()
"Determine what organism is infecting a patient."
(emycin
(list (defcontext patient (name sex age) ())
(defcontext culture (site days-old) ())
(defcontext organism () (identity)))))

Evidence combination
In MYCIN it was possible that two or more rules might draw
conclusions about a parameter with different weights of evidence.
For example, one rule may conclude that the organism in question
is E. Coli with a certainty of 0.8 whilst another concludes that it is
E. Coli with a certainty of 0.5 or even -0.8. In the event the
certainty is less than zero the evidence is actually against the
hypothesis. In order to calculate the certainty factor MYCIN
combined these weights using the formula below to yield a single
certainty factor:

Contour plot of how MYCIN

certainty factors combine. For
example, the diagonal line shows
that if , then their
Where X and Y are the certainty factors.[5] This formula can be combination is zero. The bulging of
applied more than once if more than two rules draw conclusions the contours on the
about the same parameter. It is commutative, so it does not matter quadrant shows that in that case,
in which order the weights were combined. .

The combination formula was designed to have the following

desirable properties:[1]

-1 can be interpreted as "false", +1 as "true", and 0 as "uncertain".

Combining unknown with anything leaves it unchanged.
Combining true with anything (except false) gives true. Similarly for false.
Combining true and false is a division-by-zero error.
Combining +x and -x gives unknown.
Combining two positives (except true) gives a larger positive. Similarly for negatives.
Combining a positive and a negative gives something in between.

Examples
The following examples come from Chapter 16 of PAIP, which contains an implementation in Common
Lisp of a modified and simplified version of MYCIN for pedagogical purposes.

A rule, and an English paraphrase generated by the system:

 (defrule 52
if (site culture is blood)
(gram organism is neg)
(morphology organism is rod)
(burn patient is serious)
then .4
(identity organism is pseudomonas))
Rule 52:
If
1) THE SITE OF THE CULTURE IS BLOOD
2) THE GRAM OF THE ORGANISM IS NEG
3) THE MORPHOLOGY OF THE ORGANISM IS ROD
4) THE BURN OF THE PATIENT IS SERIOUS
Then there is weakly suggestive evidence (0.4) that
1) THE IDENTITY OF THE ORGANISM IS PSEUDOMONAS

Results
Research conducted at the Stanford Medical School found MYCIN received an acceptability rating of
65% on treatment plan from a panel of eight independent specialists, which was comparable to the 42.5%
to 62.5% rating of five faculty members.[6] This study is often cited as showing the potential for
disagreement about therapeutic decisions, even among experts, when there is no "gold standard" for
correct treatment.

Practical use
MYCIN was never actually used in practice. This wasn't because of any weakness in its performance.
Some observers raised ethical and legal issues related to the use of computers in medicine, regarding the
responsibility of the physicians in case the system gave wrong diagnosis. [7] However, the greatest
problem, and the reason that MYCIN was not used in routine practice, was the state of technologies for
system integration, especially at the time it was developed. MYCIN was a stand-alone system that
required a user to enter all relevant information about a patient by typing in responses to questions
MYCIN posed. The program ran on a large time-shared system, available over the early Internet
(ARPANet), before personal computers were developed.

MYCIN's greatest influence was accordingly its demonstration of the power of its representation and
reasoning approach. Rule-based systems in many non-medical domains were developed in the years that
followed MYCIN's introduction of the approach. In the 1980s, expert system "shells" were introduced
(including one based on MYCIN, known as E-MYCIN (followed by Knowledge Engineering
Environment - KEE)) and supported the development of expert systems in a wide variety of application
areas. A difficulty that rose to prominence during the development of MYCIN and subsequent complex
expert systems has been the extraction of the necessary knowledge for the inference engine to use from
the human expert in the relevant fields into the rule base (the so-called "knowledge acquisition
bottleneck").

See also
CADUCEUS (expert system)
 Internist-I
Clinical decision support system
XCON

References
1. Norvig, Peter (2007). "16. Expert Systems" (https://github.com/norvig/paip-lisp/blob/main/do
cs/chapter16.md). Paradigms of artificial intelligence programming: case studies in Common
LISP (Nachdr. ed.). San Francisco, Calif: Morgan Kaufmann. ISBN 978-1-55860-191-8.
2. Shortliffe, E. H.; Buchanan, B. G. (1975). "A model of inexact reasoning in medicine".
Mathematical Biosciences. 23 (3–4): 351–379. doi:10.1016/0025-5564(75)90047-4 (https://d
oi.org/10.1016%2F0025-5564%2875%2990047-4). MR 0381762 (https://mathscinet.ams.or
g/mathscinet-getitem?mr=0381762). S2CID 118063112 (https://api.semanticscholar.org/Cor
pusID:118063112).
3. Buchanan, B. G.; Shortliffe, E. H. (1984). Rule Based Expert Systems: The MYCIN
Experiments of the Stanford Heuristic Programming Project (https://archive.org/details/ruleb
asedexperts00buch). Reading, Massachusetts: Addison-Wesley. ISBN 978-0-201-10172-0.
4. Heckerman, D.; Shortliffe, E. (1992). "From certainty factors to belief networks" (http://resear
ch.microsoft.com/en-us/um/people/heckerman/HS91aim.pdf) (PDF). Artificial Intelligence in
Medicine. 4 (1): 35–52. CiteSeerX 10.1.1.157.4459 (https://citeseerx.ist.psu.edu/viewdoc/su
mmary?doi=10.1.1.157.4459). doi:10.1016/0933-3657(92)90036-O (https://doi.org/10.101
6%2F0933-3657%2892%2990036-O).
5. Jackson, Peter (1999). Introduction to expert systems. Addison Wesley Longman Limited.
p. 52. ISBN 978-0-201-87686-4.
6. Yu, Victor L. (1979-09-21). "Antimicrobial Selection by a Computer". JAMA. 242 (12): 1279–
82. doi:10.1001/jama.1979.03300120033020 (https://doi.org/10.1001%2Fjama.1979.033001
20033020). ISSN 0098-7484 (https://search.worldcat.org/issn/0098-7484). PMID 480542 (ht
tps://pubmed.ncbi.nlm.nih.gov/480542).
7. Trivedi, M. C. (2014). A Classical Approach to Artificial Intelligence (2nd ed.) (https://books.g
oogle.com/books?id=nh4EEAAAQBAJ&dq=mycin+practical+use&pg=PA331). Van Haren
Publishing. p. 331
Winston, Patrick Henry, ed. (1986). The AI business: the commercial uses of artifical
intelligence (4. print ed.). Cambridge, Mass.: MIT Pr. ISBN 978-0-262-23117-6.

External links
Paradigms of Artificial Intelligence Programming, Chapter 16. (https://github.com/norvig/paip
-lisp/blob/main/docs/chapter16.md)
Rule-Based Expert Systems: The MYCIN Experiments of the Stanford Heuristic
Programming Project (http://people.dbmi.columbia.edu/~ehs7001/Buchanan-Shortliffe-1984/
MYCIN%20Book.htm) -(edited by Bruce G. Buchanan and Edward H. Shortlife; ebook
version)
TMYCIN (http://www.cs.utexas.edu/users/novak/tmycin.html), system based on MYCIN
"Mycin Expert System (https://web.archive.org/web/20120212093503/http://raa.ruby-lang.or
g/project/mycin): A Ruby Implementation" (at the Web Archive).
"MYCIN: A Quick Case Study" (http://cinuresearch.tripod.com/ai/www-cee-hw-ac-uk/_alison/
ai3notes/section2_5_5.html)
"Some Expert System Need Common Sense" (http://www-formal.stanford.edu/jmc/somenee
d/someneed.html) -(by John McCarthy)
 "Expert Systems" (http://www.cs.cf.ac.uk/Dave/AI1/mycin.html)

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