Pathfinder is an expert system that assists surgical pathologists with the diagnosis of lymph-node diseases. The program is one of a growing number of normative expert systems that use probability and decision theory to acquire, represent, manipulate, and explain uncertain medical knowledge. In this article, we describe Pathfinder and our research in uncertain-reasoning paradigms that was stimulated by the development of the program. We discuss limitations with early decision-theoretic methods for reasoning under uncertainty and our initial attempts to use non-decision-theoretic methods. Then, we describe experimental and theoretical results that directed us to return to reasoning methods based in probability and decision theory.

Most traditional models of uncertainty have focused on the associational relationship among variables as captured by conditional dependence. In order to successfully manage intelligent systems for decision making, however, we must be able to predict the effects of actions. In this paper, we attempt to unite two branches of research that address such predictions: causal modeling and decision analysis. First, we provide a definition of causal dependence in decision-analytic terms, which we derive from consequences of causal dependence cited in the literature. Using this definition, we show how causal dependence can be represented within an influence diagram. In particular, we identify two inadequacies of an ordinary influence diagram as a representation for cause. We introduce a special class of influence diagrams, called causal influence diagrams, which corrects one of these problems, and identify situations where the other inadequacy can be eliminated. In addition, we describe the relationships between Howard Canonical Form and existing graphical representations of cause. 1