title: Ideas and ideals in medicine: fruits of reason or props of power?
abstract: Editors of medical journals play a central role in the promotion -- or suppression -- of ideas and ideals in medicine. Recently eminent among these have been the advocacies of the Evidence-based Medicine (EBM) movement and others concerned with evidence and guidelines for health care. With regard to these topics, it still remains for editors of journals either to advance or to retard even the consolidation of the associated core concepts, most notably those of evidence in medicine, scientific medicine, and rational medicine. I present, first, a case study on the conduct of the editors of three medical journals, specifically their assumption of the role of authority on the scholarly fundamentals of evidence in medicine and their responding to propositions on the topic with commentaries well below the intellectual standards that should prevail in the journals of a learned profession. Then, following a brief review of the Flexnerian and EBM ideas and ideals on the practice of medicine, supplemented by observations drawn from medical sociology and the precepts of the philosophy of science, I posit a way of understanding such behaviour by editors of medical journals. They can have a temptation, and apparently some propensity, to play a regressive role in the development of the fundamentals of medicine. This is prone to occur whenever reason constitutes a threat to power, whether solely to the editors' own or to that of the profession at large. A full realization of the dream of reason in medicine requires an immense integrity of its journal editors and of its other intellectual leaders.
authors.affiliation: Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
authors.forename: O S
authors.initials: OS
authors.lastname: Miettinen
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D010506:Periodicals as Topic