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August 17, 1994

Somnambulating Into a Paradigm Shift-World Changes: Thomas Kuhn and the Nature of Science

JAMA. 1994;272(7):515. doi:10.1001/jama.1994.03520070033020

To the Editor.  —The very fine review by Richard Manning1 of World Changes: Thomas Kuhn and the Nature of Science, edited by Paul Horwich, appeared in the same issue of JAMA as a group of letters, "Managed Care, Mental Health, and the Marketplace," relating to a Commentary by Drs Jellinek and Nurcombe.2 I wondered what Thomas Kuhn would have thought of the debate.Unable to speak for Professor Kuhn, I note his interest in language, communication, paradigm, and paradigm shift. I would suppose him to say that insurers and physicians think and speak from paradigms so dissimilar that communication and the achievement of like-mindedness is impossible. Even if they use the same words (with differing intent), they talk past each other. This is not surprising: insurers are in business and their only purpose is to make increasingly larger profits. Physicians expect to earn a good living but have