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The Journal's Role in Helping Change Medical Practice


We place a great deal of faith in the results of experimentation, for it is from research data that medical innovations are born and medical practice is changed. As the volume of biomedical publications continues to increase, it is important to recognize that somewhere, buried in all that information, are studies that represent the seedbeds of change. Filtering through the data requires an understanding of the nature of research and its ability to change practice, but it also requires that we understand what produces resistance to change. New information may be unexpected and alarming. Dogma is a fact of life and of medicine.

Thomas Kuhn is widely regarded as coining the term "paradigm shift." Kuhn (l) described "revolution" as the abandonment of one theoretical structure and its replacement by another incompatible one. In this way "normal" science (a paradigm) inevitably produces crisis and revolution that leads to "new" normal science (a paradigm shift) and, ultimately, a new crisis. Puzzles that resist solution are seen as anomalies, and failure to solve the puzzle is seen as an inadequacy of the scientist rather than the paradigm. "Normal" scientists must be uncritical of the paradigm so as to concentrate on its detailed articulation and to perform the esoteric work of probing nature in great depth.

One reality is that during the crisis/revolution phase, professional insecurity sets in, followed by a change in professional allegiance. There is then no single reason to abandon a paradigm. Change occurs through persuasion rather than compulsion. A scientific revolution corresponds to the abandonment of one paradigm and the adaptation of a new one, not by an individual scientist but by the relevant scientific community as a whole. Thus, the revolution is only successful if the majority shifts allegiance.

A current sports medicine discussion relevant to science and medicine as a whole concerns fluid balance, dehydration, and hyponatremia during exercise. Last September, Senior Associate Editor Tim Noakes, MBChB, MD, wrote a commentary questioning what he calls the "dehydration myth." His observations elicited a heated response. We present both sides of the issue in our Letters to the Editor department. The emotion that characterizes this debate is complicated by the influence of research supported by the sports drink industry. When an entire industry is based on a single paradigm, additional resistance is encountered. If the medical profession purporting to uphold the virtue of science and its processes benefits substantially from a commercial interest whose desire is to maintain the status quo, then medical science misses its higher calling.

Our role at this stage is not to take sides but to give the debate a forum, which we are in a unique position to do as an independent journal. Many previous dogmas have since been refuted. An example is the change in ideas about gastric ulceration and the effects of bacterial infection (2). Let's not have it said of us in the history books that our reluctance to embrace new information or points of view prevented the advancement of the science of sports medicine, particularly as we go about protecting our beliefs in the very same name of that science. We should embrace discussion in the fullest sense of the word and in the spirit of science in much the same way that Francis Bacon described new knowledge: "Read not to contradict and confute, nor to believe and take for granted, nor to find talk and discourse, but to weigh and consider."

Gordon O. Matheson, MD, PhD


  1. Kuhn T: The Structure of Scientific Revolutions, ed 2. Chicago, University of Chicago Press, 1970
  2. Marshall BJ, Armstrong JA, McGechie DB, et al: Attempt to fulfill Koch's postulates for pylori Campylobacter. Med J Aust 1985;142(8):436-439