The scientific dichotomy and the question of evidence

For some time now, the evidence debate has been very active. Methods are valued in relation to their power to guarantee evidence. A scientific dichotomy is present: the one between qualitative and quantitative approaches, between linguistic and numeric methods. Quantitative approaches building on numeric methods are held more scientific per se. Qualitative approaches building on linguistic methods are considered less scientific. This dichotomy is not that new; it has existed for some hundred years. In short, the 17th-century revolution of natural sciences had an enormous impact on the development of all science and research. When the foundation for modern medicine was constructed, a mechanistic worldview was dominant and humans were understood as complex machines, ruled by the natural laws that regulate everything else in nature. Seen this way, health and*in particular*illness could be scientifically examined with methods that built upon mathematics and statistics. The picture was the same then as it is now: mathematics was understood as the cradle of science and that which can be examined numerically and described by statistics has higher scientific value. The main problem of contemporary health science research is not the emphasis on numeric research and statistics; instead, it is the positivist isms that still dictate scientific research. These are atomism, reductionism and what I call categorism, and they illustrate the urge to divide complex wholes into groups of small and separate parts, preferably as least common denominators, which then can be weighed and measured. Thereby, dichotomies and even dualisms have remarkable significance, such as body versus soul, health versus illness, objective versus subjective, sense versus sensibility, the rational versus the emotional. Illness is more compatible with this approach than with health, and as a consequence modern medicine deals more with illness than with health. Furthermore, illness is being defined by diagnoses and symptoms that can be quantified and against which therapies can be evaluated. Diagnoses are even contra productive as they give no clues to understanding a person's health resources or how he/she can be supported in strengthening his/her health processes. Diagnoses are powerful categories, having the capacity to change a person's self-image and identity. Focus shifts from individual to groups, since statistics mean group orientation. Diagnoses also have a normative effect*more and more of everyday existence is now being diagnosed. Not least alarming is it that modern medicine in such a way cooperates with the idea of the world as a market, …