Ann Intern Med. 2001 Oct; 135(7): 507-13.

Alternative medicine: a "mirror image" for scientific reasoning in conventional medicine.

Vandenbroucke JP, de Craen AJ.

Department of Clinical Epidemiology, Leiden University Medical Center, Building 1, PO Box 9600, 2300 RC Leiden, the Netherlands. [email protected]

A reflection on the scientific behavior of adherents of conventional medicine toward one form of alternative medicine-homeopathy-teaches us that physicians do reject seemingly solid evidence because it is not compatible with theory. Further reflection, however, shows that physicians do the same within conventional medical science: Sometimes they discard a theory because of new facts, but at other times they cling to a theory despite the facts. This essay highlights the seeming contradiction and discusses whether it still permits the building of rational medical science. We propose that rational science is compatible with physicians' behavior, provided that physicians acknowledge the subjective element in the evaluation of science, as exemplified in the crossword analogy by the philosopher Haack. This type of thinking fits very well with the Bayesian approach to decision making that has been advocated for decades in clinical medicine. It does not lead to complete and uncontrollable subjectivity because discernment between rivaling explanations is still possible through argument and counterargument.