Kuhn also wrote "The road from scientific law to scientific measurement can rarely be traveled in the reverse direction." That is a variation on Khayyam's theme "The Moving Finger writes; and, having writ, Moves on: nor all your Piety nor Wit Shall lure it back to cancel half a Line, Nor all your Tears wash out a Word of it." And Jonathan Swift said similar things with "Falsehood flies and the truth comes limping after; so that when me come to be undeceived it is too late; the jest is over and the tale has had its effect."
And since the quotation enhanced part of this string started with Max Planck and Albert Einstein, consider "Science cannot solve the ultimate mystery of nature. And that is because, in the last analysis, we ourselves are part of nature and therefore part of the mystery that we are trying to solve." (MP), followed by "Ego is the immediate dictate of human consciousness." (Max again) and "There are only two things infinite, the universe and human stupidity, and I'm not sure about the first." (Albert E)
Thus, poorly envisioned and analyzed randomized trials, inevitably flawed as they are only human devices, particularly if fed into a reductionist philosophy (1) (or even more dangerously, a dichotomizing philosophy - I shall avoid quotation here and leave you to think of your own favourite examples) result in information sludge being accepted as absolute truth to be applied in all circumstances (examples available on request). Absolute verus relative risks are rarely considered in the resulting decisions, nor whether the circumstances of the "RCT" (vide infra) are truly applicable to the context in which they are now to be applied. "Once information has been declared 'the best available evidence', particularly if that assertion is used to justify clinical practice guidelines or 'consensus', further inquiry may be inhibited. Since it it implied that 'the answers are all in', mutation from clinical practice guideline to standard of care is prompt and uncomplicated, particularly if the labels are 'consensus' or 'policy statement' are used used between the two as conceptual mutagens." (2)
Notwithstanding "The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients", the critical qualifiers "conscientious", "explicit", "judicious" and "individual" fall away in favour of devout faith in the faith-based labels "Randomized Controlled Trial", "Metaanalysis" and "Evidence Based Medicine". Even better, two of the three are shortened into three letter acronyms, an epistemologic tipoff that thought has stopped altogether. Those daring to question validity of any examples within those mantras are branded, marginalized by the Consensus Cult (3) and written off as "heretic", "cynic" or perhaps "postmodernist". This, even to the extent of universities penalizing students and staff who say or write unpopular things (4). Yet "heretic" comes from the Greek "hareio", "I choose for myself", so perhaps that would be "choose to think for myself", rather than trusting and relying on someone else's revealed truth and the presumption that it comes from a transcendent plane, as opposed to a human.
In "Breaking out Michel Foucault" (Salamagundi, 1993) David M. Halperin wrote "Truth is a discursive strategy that - among other things - blocks inquiry into the conditions of its own production." We ignore that to our peril in acronymic, reductionist thinking, which we are all prone to in the so-called "Information Age".
P.F.Hall,
U of Manitoba,
Winnipeg, MB, CANADA
1. "A reductionist philosophy is a very bad way of understanding how biological living systems work. It's only part of a much richer picture. A reductionist philosophy produces some extremely dangerous ideologies of biological determinism, and some extremely hazardous technologies. (Steven Rose The making of memory: from molecules to mind. Toronto: Anchor Books, Doubleday 1992)
2. Menticoglou S, Hall PF Routine induction of labour at 41 weeks gestation: nonsensus consensus BJOG 2002;109:489-91
3. Hall, PF The Consensus Cult JSOGC 2000; 22: 1 (8)
4. For examples see www.thefire.org
Philip F. Hall, MD BScMed FRCSC
Professor, Faculty of Medicine, University of Manitoba
Director, Fetal Assessment, Manitoba Obstetric Outreach and Maternal-Fetal Medicine Programs
Vice President, Medical Staff
St.Boniface General Hospital, 409 Tache Avenue D2044
Winnipeg, Manitoba, Canada R2H 2A6
ph 204-237-2547 FAX 204-233-1751
(Past Chair, Obs & Gyn Specialty Committee,
Royal College of Physicians & Surgeons of Canada)
<www.umanitoba.ca/womens_health>
>>> Eric Harvey <[log in to unmask]> 01/22/04 06:32PM >>>
"But if a paradigm is ever to triumph, it must gain some first supporters, men who will develop it to the point where hardheaded arguments can be produced and multiplied. And even those are not individually decisive. Because scientists are reasonable men, one or another argument will ultimately persuade many of them. But there is no single argument that can persuade them all. Rather than a single group conversion, what occurs is an increasing shift in the distribution of professional allegiances." Thomas Kuhn, 1962
Despite our advanced technology, the approach to the practice of medicine (like the practical applications of the scientific method to any discipline) remains best communicated through interpersonal interaction. As much as we would like everyone to read what we have read and see the light, we must all do the hard work of developing the "hardheaded arguments" and presenting them to our trainees and peers.
Eric
----- Original Message -----
From: Jim Walker
To: [log in to unmask]
Sent: Thursday, January 22, 2004 3:45 PM
Subject: Re: sad
I think Max Plank explained the phenomenon some time ago: ". . .a new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it."
Einstein never was able to accept much of quantum mechanics.
Jim
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