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Martin J. Tobin, MD
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Edward Hines Jr. Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine Hines, IL

Correspondence to: Martin J. Tobin, MD, Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines IL 60141; e-mail: mtobin2@lumc.edu

In 2007, the author received $1,044.22 for contributions to UpToDate, and receives royalties for two books on critical care published by McGraw Hill.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


In 2007, the author received $1,044.22 for contributions to UpToDate, and receives royalties for two books on critical care published by McGraw Hill.

In 2007, the author received $1,044.22 for contributions to UpToDate, and receives royalties for two books on critical care published by McGraw Hill.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(1):246. doi:10.1378/chest.08-2234
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To the Editor:

I thank Drs. Sestini and Irving for their comments on my article.1 It is apposite that Drs. Sestini and Irving refer to Karl Popper's writings on falsification and the demarcation problem. Popper, the foremost philosopher of science in the 20th century, devoted much effort to distinguishing between fields that fall under the name of science and fields that fall outside that rubric. He argued that falsification (a concept allows itself to be tested, and it is possible to prove it false) is the best criterion of demarcation. Popper took Eddington's experimental testing of Einstein's general theory of relativity as his exemplar of falsification. Testing a concrete prediction is the very essence of a science.

Popper took Freudian psychoanalysis as his exemplar of “nonscience.” In contrast to the specific predictions of relativity theory, psychoanalysis offered no opportunity for falsification. Thus, Popper categorized psychoanalysis as a nonscience. Drs. Sestini and Irving say that it does not make sense to test the validity of evidence-based medicine, a view shared by Haynes2 and by Straus and McAlister.3 As such, evidence-based medicine is a perfect example of Popperian nonscience.

Popper's views on nonscience are enlightening4; the acceptance of Freudian theory had:

the effect of an intellectual conversion or revelation, opening your eyes to a new truth hidden from those not yet initiated. Once your eyes were thus opened you saw confirming instances everywhere: the world was full of verifications of the theory. Whatever happened always confirmed it. Thus its truth appeared manifest; and unbelievers were clearly people who did not want to see the manifest truth; who refused to see it … The Freudian analysts emphasized that their theories were constantly verified by their ‘clinical observations.’

Substitute evidence-based medicine for where Popper writes Freudian, and the reader has a perfect description of evidence-based medicine and its advocates. History has a way of repeating itself—the second time as farce, as pointed out by Marx. The letter by Drs. Sestini and Irving brings to mind the comment of Peter Medawar (1960 Nobelist) that a debate on psychoanalysis (again read evidence-based medicine) is “never much more than a skirmish, because … its doctrines are so cunningly insulated from the salutary rigours of disbelief”—not being open to falsification.5

Tobin MJ. Counterpoint: evidence-based medicine lacks a sound scientific base. Chest. 2008;133:1071-1074. [PubMed] [CrossRef]
 
Haynes B. What kind of evidence is it that evidence-based medicine advocates want health care providers and consumers to pay attention to? BMC Health Serv Res. 2002;2:3. [PubMed] [CrossRef]
 
Straus SE, McAlister FA. Evidence-based medicine: a commentary on common criticisms. Can Med Assoc J. 2000;163:837-841
 
Popper K. Conjectures and refutations: the growth of scientific knowledge. 1963; London, UK Routledge:45-46
 
Medawar P. The strange case of the spotted mice and other classic essays on science. 1996; Oxford, UK Oxford University Press:130
 

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References

Tobin MJ. Counterpoint: evidence-based medicine lacks a sound scientific base. Chest. 2008;133:1071-1074. [PubMed] [CrossRef]
 
Haynes B. What kind of evidence is it that evidence-based medicine advocates want health care providers and consumers to pay attention to? BMC Health Serv Res. 2002;2:3. [PubMed] [CrossRef]
 
Straus SE, McAlister FA. Evidence-based medicine: a commentary on common criticisms. Can Med Assoc J. 2000;163:837-841
 
Popper K. Conjectures and refutations: the growth of scientific knowledge. 1963; London, UK Routledge:45-46
 
Medawar P. The strange case of the spotted mice and other classic essays on science. 1996; Oxford, UK Oxford University Press:130
 
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