PHM-Exch> Evidence-based medicine conceptual cul-de-sacs and some off-road alternative routes

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC)
crossposted from: EQUIDAD at listserv.paho.org


** ** ** ** ** **

*Why do we always end up here?**
Evidence-based medicine’s conceptual cul-de-sacs and some off-road
alternative routes

*

Trisha Greenhalgh, Healthcare Innovation and Policy Unit, Centre for
Primary Care and Public Health, Barts and The **London** **School** of
Medicine and Dentistry, ****London**, **United Kingdom********

*J PRIM HEALTH CARE - 2012; 4(2):92–97 *http://bit.ly/O01QYX****


‘’…………Let me explain what I mean by ‘conceptual cul-de-sacs’. Thomas Kuhn
proposed that science progresses in paradigms—a paradigm being a set of
assumptions and beliefs shared by a group of sci­entists about what the
important questions are and how they should be tackled.4 Most scientists,
most of the time, work within an existing paradigm and build rather
doggedly on what has gone before. This is what Kuhn called ‘systematic
puzzle-solving’, Wittgenstein called ‘the railway tracks of science’5 and
Einstein called ‘99% perspiration’.

****

Occasionally, someone (often a youngster new to the discipline or perhaps
someone in a second career) questions the prevailing assumptions and
methodological rules—Einstein’s ‘1% inspiration’. A fight ensues, with the
newcomer typically re­jected by the old school as ignorant or not rigorous,
and a breakaway group forms. The most famous ex­ample of this is Einstein
himself, who challenged the assumptions and methods of Newtonian phys­ics
and started playing to new rules, allowing new questions to be addressed in
a whole new way.

****

Paradigms are not bad things. They don’t just constrain our thinking, they
enable us to think.6 Science could not progress without them. We learn the
rules, apply them, argue about them, modify them. Indeed, Susan Leigh Star
defined a discipline as ‘a commitment to engage in disagreements’.7 If
you’re a geneticist and a historian challenges your work, you won’t get
very far. But with a fellow geneticist, you can have a good argument and
make progress.

****

The pre-paradigmatic research of off-road breakaway groups is typically
slow, messy and charac­terised by wrong turnings and periodic pile-ups.4 But
eventually some tracks are laid and a clear direction of travel is pointed
out. Yesterday’s radicals become today’s sticklers for procedure.
Disagreement, and therefore progress, becomes possible. A new paradigm is
born……….”
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