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Year : 2018  |  Volume : 5  |  Issue : 3  |  Page : 121-122

Evidence-based medicine: A scientific movement or a paradigmatic shift?

Community Medicine Specialist, Education Development Center, Mazandaran University of Medical Sciences, Sari, Iran

Date of Web Publication10-Dec-2018

Correspondence Address:
Dr. Siavash Moradi
Community Medicine Specialist, Education Development Center, Mazandaran University of Medical Sciences, Sari
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JNMS.JNMS_31_18

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How to cite this article:
Moradi S. Evidence-based medicine: A scientific movement or a paradigmatic shift?. J Nurs Midwifery Sci 2018;5:121-2

How to cite this URL:
Moradi S. Evidence-based medicine: A scientific movement or a paradigmatic shift?. J Nurs Midwifery Sci [serial online] 2018 [cited 2024 Feb 27];5:121-2. Available from: https://www.jnmsjournal.org/text.asp?2018/5/3/121/247109

Dear Editor,

My interest in the precise understanding and proper use of the glossary of the philosophy of science in the field of medical science has led to a vast and holistic search in philosophical references, and in this letter, I intend to point to an unintended mistake that has led to the excessive use of the word paradigm in the philosophy of medicine.

The use of philosophical glossary in justifying the scientific developments in the medical world is so widespread that some inevitably create complex patterns and models to show the least changes in the evolution of medical science. This is because the multiplicity of the paradigms defined in the field of medical science, especially in the last few decades, has led to confusions in understanding even the simplest issues in the field of medical science. Therefore, the author intends to discuss the emergence of new conceptual models in the medical world, especially evidence-based medicine (EBM), in the form of conceptualizing scientific paradigm and scientific movement.

The scientific paradigm is of the most fundamental concepts in the philosophy of science, which was first proposed by Kuhn (1922–1996).[1] From Kuhn's point of view, when a paradigm fails to answer the most commonly asked questions in its scientific field, it is replaced by another paradigm. Explaining the noncumulative assumption of science, Kuhn suggested that the old and the new paradigms are mutually exclusive, and hence, the new paradigm is not superior to the previous one, but rather a completely different one, and thus, scientific evolution has no directions.[2]

Contrary to Kuhn's view, Popper (1902–1994) believes that science is in a constant revolution and its fundamental principles constantly exposed to universal critique. Therefore, from his point of view, science must be understood as an ever-growing phenomenon.[3]

There is no doubt that Kuhn's paradigmatic interpretation of the sudden and mutational evolution of sciences was effective in the formation of the foundations of medical philosophy. Indeed, the revolutionary opinion of Fleck (1896–1961), the first philosopher of modern medicine, based on the absence of absolute scientific fact,[4] was empowered by the publication of Kuhn's book, “The Structure of Scientific Revolutions” in 1970.

Certainly, one of the most rigorous paradigmatic shifts in the history of medicine was presented in 1981 by Engel (1913–1999) where he introduced the biopsychosocial model instead of the dominant biomedical model.[5]

Along with all that the medical philosophy has introduced for or against Kuhn's thoughts, the hermeneutic approach of Gadamer (1900–2002) to medicine is of paramount importance. Gadamer, in his book, “The Enigma of Health,” according to the artful dimension of medicine considers the patient as a text, not as a pure mechanical body.[6] This perception is fully consistent with the predominant biopsychosocial paradigm.

Although the primary definition of EBM provided by Sackett,[7] emphasized employing the best evidence for individual patient, short after it, the best evidence, clinical expertise, and patients' preferences were accepted as the three fundamental components of the EBM. In this sense, perhaps, it would be better to consider EBM as playing a role among the process of medical evolution because it both implicitly accepted the previous model based on expert opinion and considered the application of evidence without taking into account the patient's preferences insufficient for making the best clinical decision. The widespread epistemological and ethical criticism impeding the concept of EBM in almost a decade since the formation of it[8] shed doubt on the dominance of it as a new paradigm.[9] Although the author, at the EBM International Congress, designed the dialogue between EBM and traditional medicine as two competing paradigms,[10] but his belief about the scientific revolution in the medical arena is close to Karl Popper's opinion and believes that any form of medical revolution, including the formation of the concept of EBM, is due to the cumulative nature of science.

In conclusion, like many other types of science, clinical sciences have an evolutionary development. Therefore, traditional medicine, current medicine, and future medicine are on the same track. In this path of development, EBM as a movement in clinical sciences is intended to be placed next to a variety of paradigmatic changes without being considered as an independent paradigm.

Conflicts of interest

There are no conflicts of interest.

Author contribution

SM, the whole process of paper preparedness from conception to final review.

Financial support and sponsorship


  References Top

Kuhn TS. The Structure of Scientific Revolutions. Chicago: The University of Chicago Press; 1970.  Back to cited text no. 1
Okasha S. Philosophy of Science: A Very Short Introduction. Oxford, UK: Oxford University Press; 2002.  Back to cited text no. 2
Popper KR, Notturno MA. The Myth of the Framework: In Defense of Science and Rationality. London, New York: Routledge; 1997.  Back to cited text no. 3
Fleck L. Genesis and Development of Scientific Fact. Chicago: The University of Chicago Press; 1981.  Back to cited text no. 4
Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137:535-44.  Back to cited text no. 5
Gadamer HG, Gaiger J, Walker N. The Enigma of Health: The Art of Healing in a Scientific Age. Stanford (California): Stanford University Press; 1996.  Back to cited text no. 6
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: What it is and what it isn't. BMJ 1996;312:71-2.  Back to cited text no. 7
Cohen AM, Stavri PZ, Hersh WR. A categorization and analysis of the criticisms of evidence-based medicine. Int J Med Inform 2004;73:35-43.  Back to cited text no. 8
Hickey DS, Hickey A, Noriega LA. The failure of evidence-based medicine? Eur J Pers Cent Healthc 2012;1:69-79.  Back to cited text no. 9
Moradi S, Hosseini A. Iranian traditional medicine and evidence-based medicine: An overview of dialogue between two paradigms. BMJ Open 2017;7.  Back to cited text no. 10


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