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Shifting paradigms
  1. C Niek Van Dijk
  1. Correspondence to Professor C Niek Van Dijk, Academic Medical Center Amsterdam, Meibergdreef 9, Amsterdam 1105AZ, The Netherlands; C.NiekvanDijk{at}

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It was Thomas Kuhn, a philosopher of science, who taught us about paradigms.1 A paradigm is defined as an intellectual perception accepted by an individual or a group of individuals as a fact of truth. It is accepted as a model of how things work for that person. And yes, the members of a given scientific community share a paradigm at any one time. And they all share it contently as long as it works. As long as there aren’t too many anomalies, that is, deviations which it can’t solve.

But once the inconsistencies grow, they begin to threaten the paradigm and then you have a period where the ‘old guard’ defends it against a new generation who are promoting a new paradigm. A new paradigm which they think can explain and overcome the anomalies. In the transition period, we see some scientists who try to prove by all means that their assumption is right: forcing a square peg in a round hole or trying to reshape the hole.

We pride ourselves on our ‘evidence-based medicine’. But does the evidence apply to this particular patient who’s sitting opposite you, in your outpatient clinic? Hmmm, not necessarily so….

In this issue, we have several articles about challenging existing …

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