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Philosophy of science and physiotherapy: An insight into practice
Roger Kerry a; Matthew Maddocks b; Stephen Mumford c
a
Associate Professor, Division of Physiotherapy Education, University of Nottingham, Nottinghamshire, UK b
Division of Physiotherapy Education, University of Nottingham, Nottinghamshire, UK c Department of
Philosophy, University of Nottingham, Nottinghamshire, UK
Online Publication Date: 01 November 2008
To cite this Article Kerry, Roger, Maddocks, Matthew and Mumford, Stephen(2008)'Philosophy of science and physiotherapy: An
insight into practice',Physiotherapy Theory and Practice,24:6,397 — 407
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Physiotherapy Theory and Practice, 24(6):397–407, 2008
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ISSN: 0959-3985 print/1532-5040 online
DOI: 10.1080/09593980802511797
Philosophy of science and physiotherapy: An insight
into practice
1
Roger Kerry,1 Matthew Maddocks,2 and Stephen Mumford3
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Associate Professor, Division of Physiotherapy Education, University of Nottingham, Nottinghamshire, UK
2
Division of Physiotherapy Education, University of Nottingham, Nottinghamshire, UK
3
Department of Philosophy, University of Nottingham, Nottinghamshire, UK
This article presents an overview of the philosophy of science and applies such philosophical theory to
clinical practice within physiotherapy. A brief history of science is followed by the theories of the four
most commonly acknowledged philosophers, introduced in the context of examples from clinical
practice. By providing direct links to practical examples, it demonstrates the possibilities of relating the
logical basis of this field of study to the clinical setting. The relevance to physiotherapy is that, by
relating this theory, clinicians can better understand and analyse the fundamental logic behind their
practice. The insight this provides can benefit professional development in several ways. For the clinician, it permits more comprehensive and coherent reasoning and helps to relate evidence with respect to
individual patients. On a larger scale, it encourages reflective discussion between peers around the
virtues of alternative treatment approaches. Thus, this topic has the potential to guide clinical practice
toward being more scientific and may help raise the credibility of the profession as a whole.
Introduction
Increasingly, physiotherapy clinicians are
required to practice as scientists. They must reason
their clinical decision making, deliver practice
in light of best available evidence, and build upon
their knowledge and expertise to fulfil the professional responsibilities set out by governing
bodies (CSP, 2007a,b; Higgs and Titchen, 1998).
Amongst peers, clinicians also have to justify why
they follow a particular treatment approach or
favour one therapeutic modality over another.
There is a constant demand to communicate judgements in a logical, coherent manner.
An appreciation of the philosophy of science
may help clinicians explore the logic underlying
their clinical practice. This field of philosophy
examines the assumptions, foundations, and impli-
cations of science (Klee, 1997), as well as the
manner in which it progressively explains phenomena and predicts occurrences with more accuracy
(Chalmers, 1999; Ladyman, 2002). Understanding
philosophers’ theories can help clinicians gain
insight into their reasoning; formulate logical,
coherent arguments to justify their practice; and
relate evidence with regard to individual patients.
As a result, they should be better equipped to
engage in challenging discussions with peers to
debate various treatment choices and contest their
own and each other’s practice. Thus, the application
of philosophical theory can not only help individuals develop their practice but may guide overall
clinical practice and raise the credibility of the
profession as a whole.
Previous health science authors have discussed
aspects of philosophies of science in the context
Accepted for publication 19 December 2007.
Address correspondence to Roger Kerry, Division of Physiotherapy Education, University of Nottingham, Hucknall
Road, Nottingham NG5 1PB, UK. E-mail: [email protected]
397
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Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407
of their discipline: physiotherapy (Noronen and
Wiksröm-Grotell, 1999; Parry, 1997; Robertson,
1995; Robertson, 1996), chiropractic (Coulter,
1991), and nursing (Nyatanga, 2005). However,
these are generally targeted toward researchers and
seldom attempt to relate philosophical theory to
clinical practice. Therefore, the utility of this topic
to clinicians may seem unclear.
This article provides a brief overview of classic
and contemporary philosophies of science and
relates them directly to examples of physiotherapy practice. The main text begins with a brief
historical background to science. Thereafter, the
four most commonly acknowledged philosophies
are covered under subheadings that refer to the
main premise of each. Subsections begin with
boxed text in which an example from clinical
practice and the clinician’s thoughts are provided. The practice is then examined in light of
the philosophical theory. We demonstrate this as
a mechanism for clinicians to gain more understanding of the science underpinning their practice, which can benefit professional development.
Philosophies of science
Historical background to scientific
thought
Throughout history humans have been fascinated with understanding how things work and
the pursuit of truth. Truth has been sought
through many methods of enquiry. These have
ranged from faith in the mystical to structured,
systematic approaches. The latter methods can
be considered as scientifically superior, and the
validity of these methods lies in the strength of
the logical basis in which they are embedded
(Fisher, 2008). The concept of logic was developed by Aristotle (384–322 B.C.) and was
arguably the most important development in
mechanisms of inquiry and decision making
(Tarnas, 1996). Aristotelian logic is referred to
as naive deduction. This means that from the
premises of A and B, someone can deduce C
(logical conclusion). For example:
Premise A: All back pain is related to a disc
dysfunction.
Premise B: Mr X has back pain.
Conclusion C: Mr X’s back pain is related to
a disc dysfunction.
Thus, if premises A and B are true, then it is a
logical necessity that C is also true (discussing the
truth of premises A and B is beyond the scope
of this article). According to this Aristotelian
thought, it would be illogical, and therefore less
valid, to simply state ‘‘Mr X has intervertebral
disc dysfunction,’’ without the support of the
preceding premises.
Later on, during the scientific revolution,
Francis Bacon (1561–1626) proposed a new tool—
novum organtum—as the basis for scientific
method (Jardine and Silverthorne, 2000). In contrast to Aristotelian naı̈ve deduction, Bacon’s
method of induction relies on observation, rather
than logical inference, as the basis for proposing
truthful statements. According to Bacon, observational experiments are relied upon to establish
laws. The observer begins with absolutely no prior
facts or biases regarding the subject of observation (presuppositionless observation) and simply
accumulates data from which a law or statement
can be induced. The following is an example of
inductive logic:
‘‘If all observed back pain patients have poor
local muscle control then all back pain patients
have poor muscle control.
Before becoming aware of these observation
results, I had no opinion on what the causes of
low back pain would be.
I now have 20 years experience and have seen
over 1000 patients with low back pain. I recognise a pattern, based on my experience, of back
pain being related to poor muscle control.
Therefore my next patient with low back will
also have poor local muscle control.’’
Induction remained the epistemological basis of
scientific discovery until the early 20th century
when the method of scientific enquiry was significantly challenged (Chalmers, 1999). The following sections present four simple clinical
reasoning scenarios, which are examined in line
with the four most reported 20th-century philosophies of science. It is anticipated that these will provide the reader with an insight into how the logical
basis of clinical practice can be philosophically
examined.
Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407
Primarily, Popper argued that presuppositionless observation (the inductive prerequisite of
observations having no bias) is not possible, given
the rich and complex nature of human perception
(Popper, 1963). His concern was that if induction is used to define or demarcate a discipline as
scientific, and inductive logic is flawed, all those
disciplines that claim to be scientific (and thus
virtuous) on this basis might not actually be so.
A revised criterion of falsification was put
forward for the demarcation of scientific activity
(Popper, 1980, pp 34–42). This entailed that to be
scientific, a discipline must hold theories from
which derivative predictions (hypotheses) can be
deduced that are testable and capable of being
falsified (Figure 1). Popper used the early 20thcentury practice of psychoanalysis to highlight
the demarcation between science and what he
termed pseudo-science (Popper, 1963). He was
disturbed that the psychoanalysts were making
strong proclamations that their discipline was
scientific. Freud and Adler theories could be used
to explain any conceivable event. In this case, the
inherent vagueness of the theories renders them
unfalsifiable and therefore not scientific.
Many other disciplines (e.g., political movements, astrology, and homeopathy) attempt to proclaim scientific status, but in Popperian terms are
actually nothing more than science-masqueraders.
This phenomenon has been referred to as the
‘‘pseudo-scientific hijacking’’ of science (Dawkins,
1998). On a social level this is much more than
academic semantics and has extreme detrimental
Philosophy in clinical practice 1:
Falsification and the demarcation of
science
Clinician’s thoughts:
‘‘I hypothesise that this patient’s back pain
is most likely due to 4 possible factors:
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1)
2)
3)
4)
facet joint dysfunction;
poor local muscular control;
disc dysfunction; or
a combination of these.
I will now systematically attempt to falsify
each hypothesis through questioning and
physical examination. The hypothesis which
survives these tests to the greatest extent is the
most likely factor influencing this back pain.’’
The clinical thought process depicted above is
referred to as hypothetico-deductive reasoning. It
is a common reasoning strategy among experienced clinicians and is considered as a robust and
effective mechanism of enquiry (Higgs and Jones,
2000). The philosophical basis of this process
differs from both naı̈ve deduction and inductive
logic and is representative of falsification theory
developed by Karl Popper (1902–1994). Popper
was a proponent of the experimental model and
developed arguments against the inductive method
highlighting its many logical flaws (Popper, 1980;
Salmon, 1988).
Predictions
(Hypotheses)
399
Tested
(Deductive)
(Derived) - Logical deduction
Corroborated
Falsified
Theory
Temporarily “Verified”
Permanently “Falsified”
Figure 1. Scientific structure according to Popper describing the process of falsification (authors’ own).
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Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407
effects on the public understanding of science.
Popper logically challenged the proposition that
inductive method was the criterion of demarcation. He dismissed how induction used tautology
and language philosophy to ‘‘prove’’ the metaphysical ‘‘nonsensical twaddle’’ of pseudoscientific disciplines (Popper, 1980, p 35). The
dogmatic and institutionalised teaching and
training of physiotherapy cults, together with the
unfalsifiable and panacean proclamations of the
physiotherapy ‘‘theorists,’’ are perhaps examples
of physiotherapy entering the domain of pseudoscience (Rivett, 1999). Examples of practices
involving unfalsified and unfalsifiable theories are
shown below. According to Popper’s way of
thinking, these practices demarcate a disciple as
being pseudo-scientific.
a) Unfalsified theory: I have a theory of
‘movement impairment’ which explains
this back pain. I am so convinced by
this explanation that I do not need to
consider other explanations nor test
my theory. I will begin treating right
away in accordance with this theory.
b) Unfalsifiable theory: My theory of
movement impairment cannot be
argued against as I can always find
some sort of movement dysfunction
in anyone. If someone else does find
out that a movement impairment does
not relate to the pain, I can find
another movement impairment which
will explain the pain. I can continually
remodel my theory so it can never fail.
A second Popperian principle regards the nature of a hypothesis (Popper, 1980, pp 252–281).
To improve its scientific value, a hypothesis
should have as high an informative and nontautological content as possible, whilst still being
probable (Popper, 1980, pp 146–215). In contrast,
induction dictates that we should aim to develop
statements (general laws) with maximal probability. For example, stating: ‘‘either this back
pain is related to movement dysfunction or it is
not’’ fulfills the inductionist criterion. It may have
maximized probability to 100% truth, but it does
not help decide a meaningful diagnosis or management strategy.
Philosophy in clinical practice 2:
Scientific revolution and paradigms
Clinician’s thoughts:
I have been managing back pain patients for
a number of years using muscular-fascial
theory (i.e., pain is related to restrictions in
movement caused by the myofascial system).
Treatment of this system seemed to produce
great results in my patients. The odd patient
would sometimes not respond well, but
overall it was a great theory.
However, recently I have been working in an
environment where I see more patients for
longer term follow-up, my questioning and
communication have improved, and it
appears that there are many patients who
are not responding to this approach.
I can no longer use my theory to explain what
is happening and I now have to question its
value in the presence of so many unsuccessful
clinical outcomes.
Upon further education and reflective practice I am learning that non-biological factors
affect the prognosis of someone’s back pain
experience.
I am continuing to develop ways of assessing
and managing treatment within my new
paradigm and will eventually be comfortable
practicing within this new framework.
When I think back to the old theory, or talk
to colleagues who continue to use a purely
structural approach, there is difficulty coming
to agreement about the nature of back pain
and the best way to manage it.
Of course, my patients still have specific
myofascial or movement dysfunctions which
I do address, but within the context of the
non-biological factors which can influence
their pain experience.
The clinician’s thought process above represents a reflective and adaptive practitioner. In an
age of evidence-based practice, self-reflection,
and continual professional development, the
insight offered in this thought process makes it a
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401
Figure 2. Kuhnian Scientific Revolution (authors’ own interpretation from Kuhn, 1972).
professionally responsible and virtuous one. In
essence, this thought process represents a changing paradigm within the clinician’s practice. This
concept is attributed to a philosopher of science
called Thomas Kuhn (1922–1996).
In contrast to Popper’s view that a theory can
be broken down into small falsifiable pieces, which
in turn can be disregarded or put back into the
theory, Kuhn suggests that a theory is a whole,
irreducible package. He called these packages
paradigms (Kuhn, 1972). In Kuhn’s view it is the
acceptance of a single paradigm in a discipline that
will demarcate a science from a non-science, not
whether hypotheses within that paradigm are
falsifiable. This view does not see science as a
steady progression influenced by the accumulation
of knowledge. Rather, it proposes that science
involves the wholesale acceptance and subsequent
abandonment of paradigms. This process is coined
a scientific revolution (Kuhn, 1972). Examples of
such revolution include the shift from thinking that
planets and stars move around the Earth (geocentrism) to the Copernican theory that planets
move around the Sun (heliocentrism), or the move
from Newtonian physics to Einsteinian theory
(Ladyman, 2002). In physiotherapy, the shift from
a tissue-based model for low back pain toward a
theory led by the increasing importance of psychosocial components of pain represents such a revolution. These examples demonstrate a wholesale
abandonment of one theory—or paradigm—in
favour of another. Thus, Kuhn (1972) refers to this
activity as a paradigm shift.
So what is it that makes a science shift its underpinning paradigm? Kuhn describes a number of
stages leading up to the point in time when the
scientific discipline totally revolutionises its activity
(Figure 2).
In a state of normal science, the scientist works
uncritically of the underpinning theory. The scientist’s job is to collect data that fit in with the
assumptions of that paradigm. Data that do not
fit the paradigm is dismissed as being erroneous
(as a result of the scientist’s poor work). However,
there may come a point when these misfitting
data become overwhelming and start to threaten
the basic assumptions of the paradigm. Thus, the
discipline reaches a state of anomaly. If these data
continue and evade or resist explanation, the
discipline moves into a state of crisis. During this
state, an alternative framework of thought will
develop and eventually revolutionise the scientific
discipline. A period of new immature research
activity begins whilst the new paradigm is being
accepted before once again normal, uncritical
scientific activity resumes within that paradigm.
The nature of a paradigm and the interpretation of results emerging from within that
paradigm are two additional concepts to which
Kuhn pays particular attention (Kitcher, 2002;
Lewens, 2005). Respectively, these are known as
the ‘‘incommensurability’’ of paradigms and the
‘‘theory-ladenness’’ of data. An essential characteristic of a new paradigm is that it is incommensurable with the competing paradigm (i.e.,
there is no straightforward way of comparing the
two). This means that the detail, the language,
and the whole underpinning framework is so
different between paradigms that the scientist
must learn to operate in a completely new way.
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It also means that scientists from each paradigm
have no common language with which to communicate. For example, it would be impossible
for a Newtonian physicist to resolve a problem
associated with mass in collaboration with
an Einsteinian physicist, because the Newtonian
concept of mass is different from the Einsteinian
concept (Okasha, 2002). The detail is so embedded in the competing underpinning theories that
singular comparison of detail cannot be made.
This theory-relative view of detail is also the
premise of Kuhn’s thoughts regarding the theoryladenness of data. As above, Kuhn argues that
traditionalist views of science are erroneous in
that they attempt to make science too objective.
Kuhn’s holistic interpretation means that to
attempt to analyse data in isolation from its
underpinning theory is wrong—all data is contaminated with theory. This immediately questions
the validity of the concept of objective truth (i.e.,
this theory-ladenness notion implies that truth is
relative to the environment from which it emerges). Indeed, Kuhn’s philosophy is regarded as a
major driving force for sciences, in particular the
social sciences, to embrace the cultural, social, and
environmental relativism of truth (Longino, 1990).
By relating these concepts of Kuhnian philosophy of science to clinical practice, the clinician’s thought process can now be superimposed
onto a framework of scientific activity. This is
demonstrated in Figure 3.
Philosophy in clinical practice 3:
Sophisticated methodological
falsification
Clinician’s thoughts:
I am quite certain that on a basic level, back
pain is related to some form of movement
dysfunction. This assumption of pathokinesiology is so basic, generic, and supported
within the sphere of manual therapy that it is
essentially unchallengeable.
However, I have other ideas that are more
specific (e.g., joint dysfunction, disc dysfunction, myofascial dysfunction, local muscle
control, and psycho-social theories). Some of
these ideas may turn out to be invalid. Others
might continue to be successful theories I use
in my practice.
It is, however, unlikely that my core theory
of movement dysfunction is going to be
radically falsified or revolutionised due to its
adaptability and acceptance by practitioners
over many decades.
This thought process represents a development from both Popperian and Kuhnian models.
It appears to embrace a core paradigm (movement
theory) whilst at the same time develop specific,
falsifiable ideas (e.g., joint dysfunction and disc
dysfunction) that contribute to the overriding paradigm. This thought process is aligned to philosophical concept of a research programme, and more
completely, Sophisticated Methodological Falsification. These concepts have been developed by
philosopher Imre Lakatos (1922–1974).
Lakatos worked on his philosophy during the
1960s whilst based in the same department as Karl
Popper, whose theory of knowledge in part inspired his ideas. Lakatos (1999c) did not advocate
for inductivism but favoured deductive explanation
born through trial and error. Lakatos’s first
standpoint is that theories offering explanations to
problems must come in whole packages rather than
by piecing together individual observation statements as Popper allowed. He proposed that theories originate as a vague set of key ideas and
concepts, which are developed and clarified as the
theory grows (Lakatos, 1970, p 173). The generation of proof or evidence for or against a complete theory should not serve to close the issue but
to allow the theory to be modified or grow. The
proof procedure, to Lakatos, is essentially a long
process of fumbling and trying again and again.
He presents theories as opportunities for growth
(in knowledge) and coins them ‘‘research programmes’’ (Lakatos, 1970, p 132; Lakatos, 1999b).
Each research programme contains two coexisting heuristics (approaches to discovery or problem solving) that provide both negative and
positive guidance. The negative heuristic involves
an unchallengeable core of basic assumptions,
ideas, or concepts that are proven and universally
supported. In the boxed example above the core
theory is that low back pain is related to movement dysfunction (pathokinesiology), a notion
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Figure 3. Kuhnian philosophy: Analysis of clinician’s thoughts.
that most clinicians would support. Any observations that are contrary to this core do not serve
to refute the theory. Instead, they encourage the
formulation of supplementary hypotheses that
serve to build a ‘‘protective belt’’ around the core
(Lakatos, 1999b). These supplementary hypotheses represent the positive heuristic, a list of
anomalies or peripheral assumptions that need to
be worked on. Unlike the core, these are refutable
and should be adjusted accordingly following
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Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407
observations (Lakatos, 1970). In the example
provided, myofascial theory and local muscle control serve as peripheral assumptions to the
core theory of pathokinesiology. If evidence in
support of either these assumption arises, the
‘‘low back pain is related to movement dysfunction’’ theory is developed and might incorporate
reference to the particular assumption concerned.
Equally, if observations refuting an assumption
arise, this assumption would no longer supplement the core theory and would be modified or
abandoned (Lakatos, 1970, pp 134–135).
The success of each research programme (or
theory) is dependent on its longevity; the length of
time it withstands tests of refutation. If adjustments to the assumptions in the protective belt
permit new predictions, which are consequentially
corroborated, these add to the cumulative growth
of the theory (Lakatos, 1999a). Conversely, if
observations consistently refute the peripheral
assumptions, these degenerate and no longer serve
to protect the core. If this happens repeatedly to
the majority of the assumptions, the theory is left
unprotected, ceases to grow, and is ultimately
abandoned. This process is termed Sophisticated
Methodological Falsification (SMF) (Lakotos,
1970, p 122) and may be seen as an extension of
the Popperian concept of falsification. SMF may
provide a more realistic and encompassing reflection of how a clinician might practice. Reasoning
is usually based on several components or aspects
of an underlying theory. Therefore, falsification
of a single component does not mean the entire
theory is abandoned; rather, parts of it are developed and the practice of that theory is modified.
Figure 4 demonstrates SMF as a framework in
which this can take place.
Lakatos also states ‘‘there is no falsification
before the emergence of another theory; theories
are not falsified by data but other theories’’
(Lakatos, 1970, p 119). This conceptual introduction that theories compete against one another is
important. Thus, the paradigm shifts proposed by
Kuhn may not be radical changes in thought, but
simply the ‘‘overtaking’’ of one scientific theory
by another (Lakatos, 1970, p 173). Lakatos offers
Figure 4. Sophisticated Methodological Falsification. The negative heuristic of pathokinesiolgy is unchallengeable. Peripheral
assumptions related to this core assumption are falsifiable, and their response to testing will sculpt the clinician’s impression of
pathokinesiology.
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a potential resolution to the conflict between
Popper’s concept of falsification and Kuhn’s
revolutionary-based take on scientific development. Popper argues scientists should replace
refuted theories with new ones, and Kuhn argues
that evidence against a theory should be discounted (i.e., considered incompatible with that
theory or ignored). Lakatos uses SMF to acknowledge the need to modify peripheral assumptions
as a process to dictate the growth or otherwise of a
theory and determine its fate (Lakatos, 1999c).
Philosophy in clinical practice 4:
Science as an ideology
Clinician’s thoughts:
I was trained to make assessment and
management decisions for patients based
on reasoned argument, logic, and also to
seek and provide ‘‘evidence’’ whenever possible. In reward for me demonstrating that
I could do this, I received both a Bachelor
and a Master of SCIENCE degree! However, I now see that this is possibly just
another way of going about things, and not
necessarily the best way.
At times, I see this method as being restrictive to my practice and confining me to
artificial rules made up by those who simply
‘‘believe’’ that this scientific process is somehow better than other ways. Is Science ignoring the chaotic complexity of human nature
and pain?
Why can I not believe—without questioning—in say, the healing powers of magnets,
or faith, or joint mobilisation? Why should
I be forced to believe in the dogmatic,
controlled ideology of science?
Thus far, the philosophies of science have all
advocated sound reasoning and systematic progression of thought. The clinician above seems to
have ‘‘given up’’ on the idea that to be correct,
there is a need to be reasonable and logical. But is
this necessarily bad practice? If contemporaneous
professional practice should be embedded in logical reasoning and the utilisation of sound evidence, then arguably so. This final section offers
405
an alternative view that science is an unfounded
ideology and a more radical way of thinking is
philosophically justifiable.
Paul Feyerabend (1924–1994) introduced a
view of science that conflicts strongly with preceding philosophical thoughts (Ladyman, 2002).
Feyerabend (1993) was against all attempts to
rationalise the development of scientific theories
and rebelled against the method in science that
other philosophers promoted. Until this point,
science was built up to be characterised by an
essential scepticism; when observations that refuted a theory came thick and fast, defence of that
theory switched to an attack on it. Feyerabend
(1999) proposed that contrary to carrying this
essential scepticism, most scientists’ beliefs were
protected by a taboo reaction to refutation. He
believed that most scientists showed minimal and
selective scepticism, being sceptic only toward
observations challenging peripheral components of
their own theories (Feyerabend, 1978, pp 88–89).
As ‘‘believers’’ to the core of their theory, scientists
either call for the incompatibility between observations that challenge it, or simply ignore them. In
this way science has the potential to conceal or
distort the process of gaining new knowledge by
explaining it to fit around itself.
Feyerabend suggests that myth and science are
similar. He did not believe that science deserves
the status it has in society; to him it was just
another ideology (a story we are told is true even
in the absence of justification) amongst many
(Feyerabend, 1993, pp 222–223). Other rival
ideologies, he argued, would work just as well if
you believe them, but because of the dominance
of scientific ideology within the state we are
taught to ignore them (Feyerabend, 1978, p 77).
As a result, the superiority of science cannot be
demonstrated (i.e., science is only ‘‘superior’’
because we judge it to be using the standards
science dictates).
By proposing science as an ideology, rules
become detrimental. They neglect the complexity
of the conditions that influence theory change
and limit the resources available to scientists (now
believers of ideologies) to extend knowledge. The
presence of rules also makes science less adaptable and more dogmatic; users take for granted
the assumptions that go into their formation
(Feyerabend, 1993, p 231). Feyerabend thought
the idea that science ought to run according to
fixed and universal rules was unrealistic and
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pretentious—unrealistic because it offers a very
simplistic view of mans’ talents and pretentious
because it enforces its own rules at the expense
of this humanity.
This philosophy encourages freedom of choice
and ideological neutrality within scientists. Choice
between competing theories should be subjective,
and the only rule should be ‘‘anything goes’’ so
long as it is advanced and developed sensibly
(Feyerabend, 1978, p 39). Feyerabend’s philosophy argues that science as anarchistic enterprise
is more likely to encourage progress than science
operating within rules, orders, and constraints. He
believed that all ideas had the potential to expand
knowledge, even those that do not fit in with
current thought (Feyerabend, 1993, p 62).
This proposal presents a striking antithesis to
the methodology-driven philosophies preceding it.
Superficially, this could be interpreted as a ‘‘green
light’’ to engage in whatever practice the clinicians
likes. This is against the culture of evidence-based
practice and professional accountability that physiotherapy is striving for. However, Feyerabend’s
ideas do not oppose logic as the basis for sensible
development of a theory; they only contend that
methodological constraints may curb creativity. In
practice, this would still necessitate that the clinician uses reasoning and progressive thought in
their decision making. Thus, the reference in the
boxed text above to ‘‘unquestioned’’ practice
would still be considered pseudo-scientific.
Summary
The pursuit of truth and knowledge has been
a fascination of mankind throughout history.
Philosophy of science studies and comments on
the methods used by those concerned with this
quest. This area of study makes the assumption
that scientific approaches are virtuous and therefore preferable to nonscientific approaches to
problem solving. Thus, the primary concern is
the demarcation of ‘‘true’’ science from pseudoscience. This article has taken the bold step of
extracting the logic from a number of acknowledged philosophies of science and transferring
it to examples of physiotherapy practice. We
demonstrate this as a mechanism whereby clinicians can consider what might philosophically
be seen as good, virtuous practice. By gaining an
insight into the logic underlying their reasoning,
clinician’s can better understand the scientific
rigour of their practice and establish the best
approaches for the future.
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