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We need better ways to create new hypotheses and select those to test

BMJ 2012; 345 doi: (Published 27 November 2012) Cite this as: BMJ 2012;345:e7991
  1. Frank Davidoff, executive editor, Institute for Healthcare Improvement, 143 Garden Street, Wethersfield, Connecticut, CT 06109, USA
  1. fdavidoff{at}

Judging from the mass of clinical trials being published, the testing of hypotheses is flourishing in biomedicine.1 This isn’t surprising, given the currently dominant hypothetico-deductive paradigm, which has spawned a huge and well funded clinical trial apparatus. It does, however, make the current disrespect for studies that “merely” generate hypotheses all the more puzzling. (One major clinical journal, for example, tells authors who submit such papers that, “We think you picked the wrong journal; [we] rarely if ever publish hypotheses.”) But we need falsifiable hypotheses; without them, what would we do randomised trials on?2 Besides, having many candidate hypotheses increases the chances of discovering the small number of ideas that most effectively explain anomalous observations.3

Medicine’s history of stubborn adherence to inadequate hypotheses about disease aetiology and therapeutic mechanisms undoubtedly contributes to the current caution in embracing new ideas. To make matters worse, the process by which hypotheses are created is mysterious, seemingly far outside rational scientific thought.3 The great philosopher of science Karl Popper threw up his hands on this question, asserting that “there is no such thing as a logical method of having new ideas, or a logical reconstruction of this process . . …

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