Anomalies Persist, So Does the Problem of Harm

摘要

WE are very grateful to Mona Gupta and Peter Zachar for their commentaries on our paper. In our view, the main challenge for both commentators is this: do they have empirical evidence to refute our rejection (on evidence-based grounds) of the primacy of the current technological paradigm in psychiatry? Although opinions may differ about our choice of the philosophical tools we use to interpret the facts, unless there is good evidence to contradict our basic premise, their arguments will fail to reach the evidence-based medicine (EBM) gold standard that they support. We do not believe their commentaries present any empirical evidence that contradicts our critique. Before we respond, we wish to stress two points. First, we are not opposed to EBM. We believe that EBM represents a significant advance in the application of scientific principles to assist in developing a clear and rational basis for establishing the safety and efficacy of treatments used in medicine. Our position is that EBM, when properly applied to treatments in psychiatry, produces data incompatible with the technological paradigm. Furthermore, these data may be interpreted using Kuhn's work as anomalies. We therefore highlight the importance of distinguishing between the use and application of EBM in medicine, and its use and application in psychiatry. We are interested to gauge whether or not the commentaries engage with the evidence of anomalies.