In a recent article in the NEJM the author writes,>
Given the sometimes elusive and often provisional nature of scientific truth, we need to emphasize that our books are vastly incomplete and that current concepts represent only a temporary resting place for understanding, continually requiring testing and further analyses. They are not the final word but a brief stop on the path we seek: truth through science.
While encouraging students to question both new information and received dogma, we need to support respect for one another, tolerating disparate views without creating unnecessary polarization.
It is important to note that knowledge is never complete, so having the right attitude towards this uncertainty would benefit us all a great deal. What exactly entails having a dogmatic and/or critical in medicine needs to be explored further. These attitudes, which I think shouldn't be that much different in medicine, have been explored in science by historians and philosophers of science. Two most commonly cited and controversial works are those of Thomas Kuhn and Karl Popper, which also had different opinions on these matters. Darrell Rowbottom, a historian and philosopher of science examined the similarities and differences on how Kuhn and Popper thought of dogmatism and criticism in science,
In The Open Society and Its Enemies, [Popper] wrote: ‘[R]ationalism is an attitude of readiness to listen to critical arguments and to learn from experience.’ (Popper, 1945, vol. II, p. 249). In the preface to the first English edition of The Logic of Scientific Discovery, he wrote: ‘I equate the rational attitude and the critical attitude. The point is that, whenever we propose a solution to a problem, we ought to try as hard as we can to overthrow our solution, rather than defend it.’ (Popper, 1959, p. 16). Sure enough, the message is the same in Conjectures and Refutations: ‘The critical attitude, the tradition of free discussion of theories with the aim of discovering their weak spots so that they may be improved upon, is the attitude of reasonableness, of rationality.’ (Popper, 1963, p. 67) And even in more obscure places, e.g. in Popper’s response to a critique of his views on demarcation by his ex-student W. W. Bartley, we find passages such as the following:
[W]hat characterizes the scientific approach is a highly critical attitude towards our theories rather than a formal criterion of refutability: only in the light of such a critical attitude and the corresponding critical methodological approach do ‘refutable’ theories retain their refutability. (Popper, 1968, p. 94)
Perhaps we should start by noting that Popper agreed with Kuhn that ‘normal science’ exists. Unsurprisingly, however, he did not describe it in flattering terms:
‘‘Normal’’ science, in Kuhn’s sense, exists. It is the activity of the non-revolutionary, or more precisely, not-too-critical professional: of the science student who accepts the ruling dogma of the day; who does not wish to challenge it; and who accepts a new revolutionary theory only if almost everybody else is ready to accept it—if it becomes fashionable by a kind of bandwagon effect. (Popper, 1970, p. 52)
Popper (ibid.) continued by expressing pity for the predicament of ‘normal scientists’, with reference to educational norms: ‘In my view the ‘‘normal’’ scientist, as Kuhn describes him, is a person one ought to be sorry for ... He has been taught in a dogmatic spirit: he is a victim of indoctrination. He has learned a technique which can be applied without asking for the reason why... ’
Kuhn disagreed with Popper not because he thought that criticism is unimportant for scientific progress (whatever that may consist in5), but rather because he thought that it should only be occasional. (We can admit, of course, that puzzle-solving involves some criticism.
One problem with Kuhn’s suggestion is that he leaves it so vague. It is not clear, for instance, what counts as a severe trouble spot (and who should get to decide). Furthermore, it is unclear how long we should stick with a theory in the face of trouble spots. And finally, crucially, it is unclear why working with a theory for a long time should improve the chance of isolating genuine limitations of the theory. This is clearer when we consider Kuhn’s proposed strategy in the light of Duhem’s (1954, pp. 183–90) thesis—that ‘an experiment ... can never condemn an isolated hypothesis but only a whole theoretical group ... [so] a ‘‘crucial experiment’’ is impossible’.
In short, the salient question is ‘‘When should one challenge the theory itself, rather than the auxiliary assumptions used in order to derive predictions from it?’’ Kuhn seems to have suggested that the auxiliaries do (and should) always give way in ‘normal science’.7 Naturally this is completely at odds with Popper’s (1959, p. 83) dictum that: ‘As regards auxiliary hypotheses ... only those are acceptable whose introduction does not diminish the degree of falsifiability or testability of the system in question.’
Clearly it would be foolish to recommend that we should always consider theories falsified when predictions derived from them, in combination with auxiliary hypotheses, are inconsistent with observations. So Kuhn’s recommended strategy is certainly an improvement on naive falsificationism (which was never actually endorsed by Popper).
This is not the first time the importance of having a scientific attitude in medicine has been emphasized. There's more to science than just using its products or being a social practice overwhelmed with politics. It is the most successful invention we've had to understand how the world works, its methods should be open for everyone's benefit. Here's a few quotes from David Wootton's recent book,
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In stressing that science is a community activity I do not mean to imply (any more than Kuhn did) that science only has a social history, or (as relativists have it) that science is whatever scientists agree on.
What killed alchemy was the insistence that experiments must be openly reported in publications which presented a clear account of what had happened, and they must then be replicated, preferably before independent witnesses. The alchemists had pursued a secret learning, convinced that only a few were fit to have knowledge of divine secrets and that the social order would collapse if gold ceased to be in short supply. Some parts of that learning could be taken over by the advocates of the new chemistry, but much of it had to be abandoned as incomprehensible and unreproducible. Esoteric knowledge was replaced by a new form of knowledge which depended both on publication and on public or semi-public performance. A closed society was replaced by an open one.
The demise of alchemy provides further evidence, if further evidence were needed, that what marks out modern science is not the conduct of experiments (alchemists conducted plenty of experiments), but the formation of a critical community capable of assessing discoveries and replicating results. Alchemy, as a clandestine enterprise, could never develop a community of the right sort. Popper was right to think that science can flourish only in an open society.