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Harold A. Rashkis, MD, PhD
Gladwyne, Pa

JAMA. 1994;272(7):515.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

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 . . . [Full Text PDF of this Article]

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