The Case of the Proliferating Paradigms

Consider the following articles from recent medical literature: “Three Times Weekly Tacrolimus Ointment Reduces Relapse in Stabilized Atopic Dermatitis: A New Paradigm for Use” (Paller et al., 2008); “Patellofemoral Syndrome: A Paradigm for Current Surgical Strategies” (Teitge, 2008); and “Neuroplasticity After Spinal Cord Injury and Training: An Emerging Paradigm Shift in Rehabilitation and Walking Recovery” (Behrman, Bowden, & Nair, 2006). What do they all have in common? You guessed it: paradigms! If you’re conversant with the latest literature in biology or medicine, you’re probably aware that these days paradigms are a dime a dozen. Each year, hundreds of investigators announce that they have consigned antiquated theories, models, and paradigms to the trash bin of history and replaced them with radically new versions. The paradigm is dead, long live the paradigm! It seems strange, then, that so much of biological science remains stable from year to year. When historian of science Thomas Kuhn introduced the term paradigm in his 1967 book, The Structure of Scientific Revolutions, he used the term to represent revolutionary developments in science that had occurred over a period of 2,400 years (Kuhn, 1996). He illustrated sequential paradigms in physics, tracing a progression from Aristotle to Newton to Einstein. He provided the reader with similar sequences in astronomy, chemistry, and medicine. For example, Harvey’s demonstration that the heart pumps blood in continuous circulation was a radical shift from the earlier Galenic belief, held for nearly 1,500 years, that the heart’s primary function was to infuse “animal spirits” into the blood, which did not recirculate. Kuhn had something very important in mind when he coined this usage of paradigm, although critics have subsequently argued that even then the concept was not entirely clear. However, it is clear that contemporary researchers must have a much different concept in mind when they use the term. Over the years the word has become progressively more popular in biomedical research, and has been applied to developments of progressively less significance. I recently did a Medline search for articles that include “paradigm” in their titles. Prior to 1969, there were 10. The numbers nudged upward in the subsequent decade (24 citations), and thereafter began to increase geometrically: 1979-1988, 164 titles; 1989-1998, 932 titles; and 1999-2008, 2,496 titles. According to Kuhn, it took 2,400 years for physics to progress through 3 paradigms, but today’s biological scientists knock them off at the rate of 250 per annum! Language evolves. Thus, it is perfectly reasonable that a word should acquire new connotations over several decades of use. In today’s practice, the original Kuhnian definition has expanded, and paradigm is now sometimes used as a synonym for several less dramatic words, among which are proposal, hypothesis, scheme, idea, method, heuristic, approach, and treatment. For example, the article entitled “Cardioprotection: A New Paradigm in the Management of Heart Failure” proposes a different approach to treating heart failure (Maytin & Colucci, 2005). “Oxidative Stress—A Unifying Paradigm in Obstructive Sleep Apnea and Comorbidities” presents the hypothesis that a number of medical conditions associated with sleep apnea are related because they all result from oxidative stress (Lavie, 2009). A third example, “The Clinician–Patient Partnership Paradigm: Outcomes Associated With Physician Communication Behavior,” makes the unobjectionable point that good communication between client and clinician promotes better health care outcomes (Clark et al., 2008). To argue that these examples demonstrate evolution of language, in this case producing a “big tent” paradigm that takes in a number of other well-established technical terms, is interesting, but merely descriptive. It doesn’t explain why the word has become so popular. I’m going to stick my neck out here and suggest a reason for this: Today’s culture of science—reflecting popular culture as a whole—puts great stock in appearance. Often, the medium is the message, and the message is frequently much larger than reality. Celebrity may have nothing to do with talent or accomplishment; assertiveness has replaced prudence as a life-orienting virtue; and humility has almost disappeared from the cultural radar. For example, can you imagine a hospital advertising that its doctors