A paradigm shift in the medical literature
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7378.1450 (Published 21 December 2002) Cite this as: BMJ 2002;325:1450All rapid responses
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It is a pity that author forget to adjust the number of PS word use
for the total number of articles in the related year. Increase will be
less dramatic!
Competing interests:
None declared
Competing interests: No competing interests
Dear Editor,
the witty and pleasant paper by Dr. Atkin[1] raises a stimulating
point on reporting bias. It has been shown that the probability that a
clinical trial is published can be affected by the nature and direction of
its results (publication bias).[2]
Dr. Atkin’s bibliographic search shows that publications containing the
stimulating phrase “paradigm shift” in their title have had an exponential
raise since 1987. This might suggest that the “catchy title bias”,
indicating a better chance of being published for papers with an appealing
title, could be added to the (already long) list of systematic errors
menacing the quality of biomedical literature.
1. Atkin PA. A paradigm shift in the medical literature.BMJ 2002;
325: 1450-1451
2. Easterbrook PJ, Berlin JA, Gopalan R, Matthews DR. Publication bias in
clinical research. Lancet 1991;337(8746):867-72
Competing interests:
None declared
Competing interests: No competing interests
Dr Atkin assumes that using the "PS" words in the title will attract
the readers, but my own experience of the "PS" words is that they cause a
reflex shut down of cerebral activity in many. We have, however, used them
in the recent title of a catchy paper published in the Burns Journal,
"Before the Paradigm Shift: Concepts and Communication between Doctors and
Nurses in a Burns Team". I have just returned from an International
Conference in Applied Linguistics in Singapore where this paper was
discussed within the general framework of Professional Communication.
Although it was very simplistic it reflected a reality which was far more
appreciated by the linguistic and communications experts than the medical
profession. What is of interest is that when we submitted this paper to
the BMJ for the theme issues on Doctors and Nurses, (was it two years
ago?), the BMJ rejected it on the grounds that it would not be of interest
to many readers. Professional communication not of interest to Doctors and
Nurses!?
Anyway, using the qualifier "Before" does take us out of the box as
Dr Atkin exhorts and long may we stay there. The box is dark, rigid and
ultimately a fatal paradigm within which to operate and conceptualise.
Long live the paradigm, so long as it shifts, changes, evolves,
metamorphs, varies, flickers, flaps, wobbles, vacillates.
PS which IS the problem with "PS"? The "P" or the "S" or just the
combination? I really would like to know. Any comments?
Competing interests:
None declared
Competing interests: No competing interests
EDITOR - Atkin's literature search on the phrase 'paradigm shift'(1)
brings new hope to fans of the word 'paradigm'. As I am sure Mr Atkin's is
aware, Schweber had previously reported an alarming 75% decrease in the
use of the noun in the year up to 1995 (2).
It is also heartening to see the ongoing festive traditition of
hitherto little known papers in the Annals of Improbable Research reaching
a wider audience via the Christmas BMJ (3)(4)(5)
(1)Atkin PA. A paradigm shift in the medical literature. BMJ
2002;325:1450-1
(2)Schweber B. The paradigm paradox. Annals of Improbable Research
1995:1(1)
(3)Barone JE. Comparing apples and oranges: a randomised prospective
study. BMJ 2000;321: 1569-1570
(4)Sandford S. Apples and oranges: a comparison. Annals of Improbable
Research 1995;1(3)
(5)Abrahams M. Apples and oranges have previously been shown to be
remarkably similar BMJ 2001;322: 931a - 931.
Competing interests:
DJ Scoffings attended the same medical school as PA Atkin, and was always a bit competitive
Competing interests: No competing interests
Sir,
Atkin's seminal study fails to appreciate that the term ‘paradigm
shift’ is used, with growing frequency, ironically. Visual inspection of
papers which mention this term in the title suggest that in 2000 about 20%
of papers use the term tongue-in-cheek, compared to none in the period
from 1973 – 1980. Assuming an exponential trend I would predict that in
2040 all use of this concept will be ironical, and it will self-destruct.
It is likely that authors will still push out envelopes, which by then
will of course all be e-digital.
With kind regards,
Reinhard Wentz
Competing interests:
None declared
Competing interests: No competing interests
In using www.dictionary.com Dr Atkin has obtained an accurate definition of the use of envelope in the expression "pushing the envelope" but has lost the essence of the phrase. At the Wordorigins.org site he could have found the following more evocative account of the phrase's origin.
Pushing the Envelope
This is an aviation term. It means pushing the aircraft to its limits, especially in the context of flight testing. Envelope has several secondary definitions referring to a collection of curves (mathematical and engineering jargon). So in the world of aeronautical engineering the envelope is the collection of curves that describe the maximum performance of an aircraft. To push the envelope is to take the aircraft to the edge of what it was designed to do and try and take it beyond.
Competing interests:
None declared
Competing interests: No competing interests
Paradigm shifts and the medical literature
I guess that, before Thomas Kuhn, few would have used the word
paradigm. Yet Kuhn's use of the phrase "paradigm shift" seems, to me, to
indicate something more substantial than those articles that are generally
awarded its use. Indeed, claiming a paradigm shift is not really something
that should be done by an individual or group but something that comes in
retrospect and is awarded by a majority community and retrospectively.
It's akin to canonisation. Using it loosely as an advert to attract users
to an article devalues Kuhn's intended impact.
So I applaud the jocular treatment of this subject with a hint of
sarcasm. It reminds me of the progressive need to qualify a superlative
(eg, very miniscule). Let's not devalue our language.
Having said that, I stand guilty having used a "paradigm shift" (but
in my abstract rather than in my title). It will be interesting to see if
I will prove justified in having claimed such "a paradigm shift is due" (
http://www.morphostasis.org.uk/morph&imm95.htm )
Competing interests:
None declared
Competing interests: No competing interests