The Two Cultures of Biomedicine: Can There Be Consensus?

Abstract

There is a tendency to assume that medical science, medical research, and medical practice are identical, or worse, hierarchically arranged. Medical practice does operate under the umbrella of medical science, but medical practitioners do not take practice directives from medical researchers. In conceptualizing and promoting a notion of medical consensus that is different from scientific certainty, the National Institutes of Health has taken a giant step toward bridging the gap between research and practice, but the task is a tough one. My vantage point is from personal interviews with more than 300 mostly nonacademic practicing physicians in three countries who described adoption of new medical technology. 1-3 The first step in conceptualizing the relationship between science and practice should be to reject the idea that practitioners are merely slow scientists. Just as science is not practice, practice is not merely applied science. Different purposes lead to different activities, associations, information,