From: <b class="gmail_sendername">Ruggiero, Mrs. Ana Lucia (WDC)</b> <span dir="ltr"></span><div class="gmail_quote">crossposted from: <a href="mailto:EQUIDAD@listserv.paho.org">EQUIDAD@listserv.paho.org</a><br><br><br>




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<p class="MsoNormal" style="margin-left:.5in"><b><font color="maroon" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:maroon;font-weight:bold">Why do we always end up here?</span></font></b><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold"> <br>

Evidence-based medicine’s conceptual cul-de-sacs and some off-road
alternative routes<br>
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<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">Trisha Greenhalgh, Healthcare
Innovation and Policy Unit, Centre for Primary Care and Public Health, Barts
and The <u></u>London<u></u> <u></u>School<u></u>
of Medicine and Dentistry, <u></u><u></u>London<u></u>,
 <u></u>United Kingdom<u></u><u></u><u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">J PRIM HEALTH CARE
- 2012; 4(2):92–97 </span></font></b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial"><a href="http://bit.ly/O01QYX" target="_blank"><font color="black"><span style="color:windowtext">http://bit.ly/O01QYX</span></font></a><u></u><u></u></span></font></p>


<p style="margin-left:.5in"><font color="#221e1f" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:#221e1f"><br>
‘’…………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.</span></font><span><font color="#221e1f" face="Arial" size="1"><span style="font-size:7.0pt;font-family:Arial">4</span></font></span><span><font color="#221e1f" face="Arial"><span style="font-size:10.0pt;font-family:Arial"> </span></font></span><font color="#221e1f" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:#221e1f">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’</span></font><span><font color="#221e1f" face="Arial" size="1"><span style="font-size:7.0pt;font-family:Arial">5 </span></font></span><font color="#221e1f" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:#221e1f">and Einstein called ‘99% perspiration’. <br>

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<p style="margin-left:.5in"><font color="#221e1f" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:#221e1f">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. <br>
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<p style="margin-left:.5in"><font color="#221e1f" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:#221e1f">Paradigms are not bad
things. They don’t just constrain our thinking, they enable us to think.<span><font color="#221e1f" face="Arial"><span style="font-family:Arial">6 </span></font></span>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’.</span></font><span><font color="#221e1f" face="Arial" size="1"><span style="font-size:7.0pt;font-family:Arial">7</span></font></span><span><font color="#221e1f" face="Arial"><span style="font-size:10.0pt;font-family:Arial"> </span></font></span><font color="#221e1f" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:#221e1f">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. <br>
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<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font color="#221e1f" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:#221e1f">The
pre-paradigmatic research of off-road breakaway groups is typically slow, messy
and charac­terised by wrong turnings and periodic pile-ups.</span></font><span><font color="#221e1f" face="Arial" size="1"><span style="font-size:7.0pt;font-family:Arial">4</span></font></span><span><font color="#221e1f" face="Arial"><span style="font-size:10.0pt;font-family:Arial"> </span></font></span><font color="#221e1f" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:#221e1f">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……….”</span></font><br></p></div></div></div><br>