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—In his letter, Dr Rashkis invokes Kuhnian concepts in asserting that "insurers and physicians think and speak from paradigms so dissimilar that communication and the achievement of like-mindedness is impossible." He supports this claim by urging that since good insurers are interested only in profits, and good physicians are interested only in treatment, the two define "good doctor" in incommensurable ways. Insurers and government, claims Rashkis, are in the process of "forcing physicians to make a paradigm shift" and to accept the insurer's definition of "good doctor" as the "one who costs the insurer the least." Physicians, he intimates, should retrench and resist that shift.It seems to me that Rashkis' analysis is not compelling as an application of Kuhn's ideas and does not mark out an advisable orientation for the community of physicians (or of insurers) to adopt in the ongoing debate over managed health care. It
Manning RN. Somnambulating Into a Paradigm Shift-World Changes: Thomas Kuhn and the Nature of Science-Reply. JAMA. 1994;272(7):515-516. doi:10.1001/jama.1994.03520070033021