[Evidence-based medicine and art of healing: the dead end of incommensurate paradigms]

What is called the art of healing may refer to mainstream Western medicine (MM) as well as complementary and alternative medicines (CAM). MM asserts to be based on scientific evidence. The analysis of medical thought and practices in Evidence-Based Medicine (EBM) allows us to identify at least three paradigms on which MM is based: materialism (the rules of life are the rules of the natural sciences), reductionism (human diseases are diseases of the molecules) and neo-positivism (theories, diagnoses and treatments must be based on evidence). As in a mirror, CAM refer to the opposite paradigms of vitalism (life is the result of non measurable energies), holism (a whole human being cannot be fully understood from his/her parts) and relativism (there is no absolute reality nor truth, "facts are artifacts"). MM and CAM are thus based on diametrically opposed paradigms and the aim of an "integrative medicine" is aforetic. The problem is that CAM are very popular. The "art of healing" has to meet the expectations of patients wanting their illness taken into account while EBM often fails to identify a disease. EBM is thus faced with an ethical dead-end: patients must be relieved, using information based solely on scientific evidence and at the same time the use of placebo, unbeknown to them, must be rejected for ethical reasons. A solution might be found in a parallel coexistence but not in an integration, of EBM and CAM. Coexistence however does not mean coresponsibility.