a justifiable distinction between science and other modes of thought are questions that have been addressed only recently -- not only in medicine, but in anthropology as well ( Broad and Wade 1982; Brush 1974; Feyerabend 1975; Goodfield 1975).
Like many other disciplines, medical science and practice have been affected by two twentieth-century movements, existentialism and phenomenology. Both have had similar concerns, stressing the relationship between the individual and systems, between freedom and choice, with anxiety, and with truth and belief as aspects of experience. Resonating to such concepts, there is an emergent contemporary disillusionment with incessant pressure built into the reward system constantly to produce "astounding scientific data." There is also an emergent demand for a new kind of accountability. There is a growing awareness of the lack of those virtues that generations of scientists have declared inherent in the scientific endeavor. Few are offended by Kuhn when he sees the "transfer of attachment form one paradigm to another" as "not the sort of battle that can be resolved by proofs," but rather as a "conversion experience." Confidence has been replaced by mistrust as the new fields of medical ethics and malpractice law prosper, and as a growing literature testifies to the new criticism of scientific research and its protocols.
The real challenge here is to recognize that even though science is not all that some scientists say it is, this does not mean that it is none of the things they say it is; one does not wish to throw out the baby with the bath. But scientists must recognize the extraneous factors that will define the new medical imperatives in our future cultural transformations.
It is possible that medical scientific pursuits, given world enough and time to incorporate eighteenth- and nineteenth-century philosophical trends ( Burtt 1954), as well as some recent attempts to apply the phenomenological method ( Spiegelberg 1960), might be able to stand outside a paradigm of all paradigms. We mean by this that consciousness of models, of process, and of the involved self -- a constant vigilance against the arrogance of naive realism -- will help to keep "ideologies" and "values" as generators of social action, but deprive them of their power to maim the intellect.
We express special thanks to John Ross, Jr., M.D., Professor of Medicine, School of Medicine, University of California, San Diego, who provided valuable counsel on many aspects of contemporary medicine.