The NHS and the new scientism.

Correspondence QJM The NHS and the new scientism Sir, Professor Klein's commentary on the NHS R&D Programme 'The NHS and new scientism: solution or delusion?' 1 is expressed in challenging language. The challenge is perhaps more apparent than real, as careful reading reveals. Professor Klein warns us about extravagant claims for science in resolving the problems which confront the NHS. Extravagant claims are, by definition, unjustified and it would be difficult to avoid his criticisms of medical scientists who are '... occasionally carried away by their sense of mission.' Curiously, this statement however is followed by the comment that '... like all good scientists, they are also careful to stress that scientific knowledge can only be one input in decision-making in the NHS.' Few would wish to argue with this latter statement. Lack of any quotable evidence in favour of the former suggests more than a little perhaps that some of the objects being tilted at are windmills. The clinical examples subsequently cited however and the conclusions derived from them are unlikely to help in defining the boundaries of scientific knowledge in the evolution of the National Health Service (NHS). As Sir Michael Peckham's newly appointed successor, I would like to clarify my perspective on what is not a particularly difficult problem in the relationship between uncertainties in science, uncertainties in decision making and the role of 'clinical judgment' to which Professor Klein repeatedly refers. The danger of introducing an unfamiliar word in the description an important phenomenon is that it will enter common parlance before its implications have been thought through. This is particularly the case when the word ends in an 'ism' with all the consequent undertones of weltanschaung and religion. Such language is never an attractive proposition for doctors and scientists who tend to be professional pragmatists. 'Scientism' denotes a belief that valid knowledge of human beings is only obtained by the classic inductive methods of science; 2 it is opposed to the belief that intuitive processes also contribute to understanding. Whilst few clinicians would denigrate the role of a sympathetic understanding of the individual patient and his predicament, decision-making in the NHS would seem to demand rather more than introspection or intuition. Professor Klein risks further confusion by his failure adequately to distinguish two qualitatively different forms of residual uncertainty which confront both clinicians and managers despite the rapidly growing body of scientific knowledge. Failure to …