Current issues of ACP Journal Club are published in Annals of Internal Medicine


Letter

Scientific evidence and expert opinion in ACP Journal Club: commentary on commentaries

ACP J Club. 1994 May-June;120:87. doi:10.7326/ACPJC-1994-120-3-087



To the Editor

As an occasional commentator for ACP Journal Club, I was intrigued by your editorial in a recent issue concerning disagreements between authors and commentators (1) Scientific evidence and expert opinion in ACP Journal Club: commentary on commentaries. I confess to a somewhat different perspective, however, based on my interpretation of our intellectual history. In any scientific field, even strong evidence does not stifle controversies and disagreements entirely.

Throughout the Western tradition, controversy has been viewed as an important method of pursuit of knowledge, generally under the rubric of dialectic. The dialectician argues rather than observes, appeals to reason rather than experience, and pushes premises to their logical conclusions (2). It is just in the 20th century that we have adopted the view that truth can be learned only by observation and generalization from evidence. In modern thought, dialectic, far from being a method of inquiry, is useful only for disputation and criticism.

Clearly, I am not disparaging the scientific method. I would, however, encourage ACP Journal Club to hang out the dirty laundry (unreconciled differences of opinion) to the greatest extent possible. I am a member of the Editorial Board of the Archives of Neurology, and one of my colleagues runs a section on “Controversies in Neurology” that is generally agreed to be a valuable teaching tool.

Anyway, you can see that I found your editorial provocative and stimulating.

Matthew Menken, MD
Robert Wood Johnson Medical School
Somerset, New Jersey, USA

In response

Dr. Menken makes some valid points. Legitimate dissent in science is to be encouraged rather than suppressed, and controversy may contribute valuable insights. The operative term is “legitimate.” When it comes to clinical medicine, the reputations of the participants in a scientific dispute are, unfortunately, not the most important casualties. Patients will pay the price for decisions based on imperfect recollection of experience and opinions not supported by evidence. The issue raised in the editorial was concerned primarily with who is perceived to have the last word. We encourage readers to consider the authors of abstracted publications to be at least as expert as the commentators. As an extension to Dr. Menken's suggestion, when there are apparent disagreements between the evidence in the abstract and the commentator's statements, we simply ask readers to consider the evidence presented by both authors and commentators.

George Browman, MD
McMaster University
Hamilton, Ontario, Canada


References

1. Browman G.Scientific evidence and expert opinion in ACP Journal Club: commentary on commentaries. ACP J Club. 1994 Jan-Feb;A11. (Ann Intern Med. vol 120, suppl 1).

2. Adler MJ. The Great Ideas. New York, NY: Macmillan Publishing Co.;1992:1