On 2016 Jun 01, David C. Norris commented:

One must lament that our toxic politics did not countenance a proper nomination and Senate confirmation process for Dr Berwick. This would have given national audience to his passionate and infectious faith in the promise of healthcare improvement, stimulating meaningful debate on its moral and scientific basis at a most fortuitous time. In this JAMA Viewpoint, Berwick assays our healthcare politics for the activity of numerous paralytic toxins responsible for this and other lamentable lost opportunities. Of these toxins, I wish to address specifically the "Suspicion of Science" Berwick invokes, since it strikes at the heart of the medical profession's capacity to elevate our politics to a higher form – through persuasion.

One hardly need invoke the lay public's suspicion of Science (capitalized and singular, if you will)¹ to account for the medical profession’s credibility gap as it now endeavors to appeal – so often in the name of cost containment, of all things – to the several sciences that fall under the heading of comparative effectiveness. Indeed, this invocation risks seeming to absolve Medicine of the responsibility to scrutinize its own professional norms and practices for modifiable factors that widen this gap. Such self-scrutiny is entirely in the spirit of the remainder of Berwick's argument, being essential to the professional mobilization he so rightly calls for.

It would surprise few laypersons to learn of clinical medicine's troubled relationship with elementary scientific behaviors and modes of thought, as demonstrated for example by the fact that Braithwaite's excellent piece² on there-is-no-evidence-to-suggest was rightly judged necessary to publish in this same journal in 2013. Laypersons enjoy a ready access to a wide variety of subtle observations and distinctions that would alarm the Profession if appreciated more fully. In particular, alert laypersons perceive the contrast between the powerful sciences underlying medical technology, and the pervasive disorder in a clinical practice from which scientific method is largely absent.³ It may well be the expression of a uniquely American genius that, regardless of what obtains abroad, until Americans routinely experience medical practice as a profound application of scientific method to optimizing their care as individuals, they will harshly censure as premature any attempt by this profession to invoke the sciences in the service of global optimizations like cost containment.

[1] Kitcher P. Science in a Democratic Society. Amherst, NY: Prometheus Books; 2011.

[2] Braithwaite RS, 2013

[3] Weed LL, Weed L. Medicine in Denial. Charleston, SC: CreateSpace; 2011.

On 2016 Jun 01, David C. Norris commented:

One must lament that our toxic politics did not countenance a proper nomination and Senate confirmation process for Dr Berwick. This would have given national audience to his passionate and infectious faith in the promise of healthcare improvement, stimulating meaningful debate on its moral and scientific basis at a most fortuitous time. In this JAMA Viewpoint, Berwick assays our healthcare politics for the activity of numerous paralytic toxins responsible for this and other lamentable lost opportunities. Of these toxins, I wish to address specifically the "Suspicion of Science" Berwick invokes, since it strikes at the heart of the medical profession's capacity to elevate our politics to a higher form – through persuasion.

One hardly need invoke the lay public's suspicion of Science (capitalized and singular, if you will)¹ to account for the medical profession’s credibility gap as it now endeavors to appeal – so often in the name of cost containment, of all things – to the several sciences that fall under the heading of comparative effectiveness. Indeed, this invocation risks seeming to absolve Medicine of the responsibility to scrutinize its own professional norms and practices for modifiable factors that widen this gap. Such self-scrutiny is entirely in the spirit of the remainder of Berwick's argument, being essential to the professional mobilization he so rightly calls for.

It would surprise few laypersons to learn of clinical medicine's troubled relationship with elementary scientific behaviors and modes of thought, as demonstrated for example by the fact that Braithwaite's excellent piece² on there-is-no-evidence-to-suggest was rightly judged necessary to publish in this same journal in 2013. Laypersons enjoy a ready access to a wide variety of subtle observations and distinctions that would alarm the Profession if appreciated more fully. In particular, alert laypersons perceive the contrast between the powerful sciences underlying medical technology, and the pervasive disorder in a clinical practice from which scientific method is largely absent.³ It may well be the expression of a uniquely American genius that, regardless of what obtains abroad, until Americans routinely experience medical practice as a profound application of scientific method to optimizing their care as individuals, they will harshly censure as premature any attempt by this profession to invoke the sciences in the service of global optimizations like cost containment.

[1] Kitcher P. Science in a Democratic Society. Amherst, NY: Prometheus Books; 2011.

[2] Braithwaite RS, 2013

[3] Weed LL, Weed L. Medicine in Denial. Charleston, SC: CreateSpace; 2011.