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Controversies in medicine! Some pacification techniques
  1. Philip D Welsby
  1. Retired, Edinburgh, UK
  1. Correspondence to Dr Philip D Welsby, Retired, Edinburgh, UK; philipwelsby{at}

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Never argue with stupid people, they will drag you down to their level and then beat you with their experience. —Mark Twain

Controversies are disagreements that are typically prolonged, and typically the smaller the evidence the greater the controversy. Controversies are the fuel of progress because they counteract conventional wisdom that often provides reassuring but incorrect views of the world. Controversies are always irritating for the parties involved who all think they are correct. This paper contains personal ideas gleaned from experience of being chairman of a hospital medical staff committee. In retrospect I spent more time analysing the processes in action rather than the specific items.

Some necessary definitions have to be explicit before controversies can be addressed.

A fact is something that is indisputably the case. A fact may only apply to a limited situation and extrapolation to other situations may be inappropriate. Simple presentation of facts is rarely effective in resolving controversies, and such presentations paradoxically may reinforce convictions or beliefs, ‘they test your faith’. What would be your response were I to tell you that your beliefs or convictions are unscientific delusions? Thought so. Worse, the evidence is that the more knowledgeable use their knowledge as ammunition to reach their desired conclusion.1–3

Truth is a state of being in accordance with facts or reality. That a study or trial achieves statistical significance does not mean it is a fact. In practice, especially medical practice, truths may only be ‘possible’ or ‘probable’. Statistics are fundamental to interpreting studies and trials. Many important medical consensus judgements have to be made on inadequate information. Guarded predictions can be made but, for example, rare drug side effects cannot be predicted. Medical controversies almost always are based on interpretations of interpretations of underlying data. Simple questions have to be asked …

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  • Contributors PDW is the sole contributor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.