- 學位論文
醫學典範轉移導致醫療社群改變認知之探討： 以幽門螺旋桿菌成功發現對醫學影響為例
On Medical Paradigm Shift and the Change of Medical Perception： A Case Study Based on the Finding of Helicobacter Pylori and Its Impact on the Medical Science
摘要
中文摘要 本論文以2005年諾貝爾醫學獎得主馬歇爾（Barry J. Marshall）和華倫 (Robin Warren）的醫學革命為例，說明醫學典範轉移的理論問題。兩人在1982年發現幽門螺旋桿菌（Helicobacter Pylori）確定造成人類消化性潰瘍的病因，徹底改變了舊消化醫學界的認知（壓力或生活不正常等因素造成人類消化性潰瘍主因）。如此顛覆醫學傳統觀念的研究，確實印證孔恩對科學研究典範轉移（paradigm shift）特徵的重要例證。本論文以孔恩典範論為研究架構，以科學革命創造醫學典範基本主軸，輔以哈伯瑪斯溝通理論解釋兩位醫學家的溝通過程，特別點出兩位醫學家改變社群認知的努力，卻花上一輩子的時間與科學社群溝通，這個在自然科學與社會科學差異的詮釋，正說明短時間跨科學領域研究的不易。人類在消化性潰痬疾病的困擾下，為求證這個細菌與疾病的密切關係，兩位醫學家又為驗證科學真理，遵循柯霍準則完成科學事實和理論的吻合，更以馬歇爾的「以身試菌」勇敢嘗試，進而確立細菌感染的事實，創立醫學新典範等觀點，印證科學典範移轉的特徵與過程。孔恩的典範轉移論述了行動和理論的一致，完成了自然科學和社會科學解釋科學史之哲學。本論文為分析典範認知之爭議，針對孔恩典範定義引起語言學的批判，特提出不同分析的看法。同時再論及哈伯瑪斯溝通理論的學理，及其理論爭議與論辯之不同。全文重點引述社會學理論的目的，在於確實詮釋醫學典範在醫學史的現象，正可說明本論文針對醫學典範在醫學社會學上的表現，因此研究發現計有（一）消化性潰瘍確定細菌感染（二）慢性潰瘍症狀確實可痊癒（三）醫學典範確實發生轉移改變（四）科學社群確實需要溝通行動理論（五）醫學革命可影響對醫療社會學的研究發展（六）社會學理論可強化科學哲學的詮釋。回歸社會科學對科學史認知主題，醫學科學革命的史實，詳盡描述細菌史研究及幽門螺旋桿菌發現的過程，說明科學家嚐盡科學社群的阻力，排除萬難焠煉典範，歷經了23年得以被肯定的事實，印證是醫學科學革命成功的新典範。 關鍵詞： 典範轉移，幽門螺旋桿菌，消化性潰瘍，醫學革命，格式塔轉換
並列摘要
Abstract This thesis deals with the scientific discovery of the Nobel Prize winners for medicine in 2005, Barry J. Marshal and Robin Warren and its implications for paradigm shift in science asserted by Thomas Kuhn. The two scientists found the Helicobacter pylori in 1982 that caused the peptic ulcer diseases. Having challenged the cognition and assertion of conventional gastroenterological circles which assumed the factors of the disease being pressure on emotion and abnormal life style, they researched and discovered the real cause of the disease. Such research subverts the traditional and conventional medical knowledge to the extent that it confirms the importance of Kuhn’s theory of paradigm shift and Habermas’s theory of communication. The treatise especially points out that the two physicians undergone the change in medical perception, in order to solve those issues regarding the relative relation between the bacterium and the disease, thus proved scientific truth, In the history of human peptic ulcer, bacterium in fact was close to the occurrence of the disease. However, the two Australian physicians, made great effort to take another research approach and finally found helicobacter pylori as the real cause of peptic ulcer. This paper is intended at first to explore a distinction between natural science and social science. Interdisciplinary study confirmed the existence and application of Kuhn’s postulate, namely the paradigm shift in science. The interdisciplinary approach is not easy to explain the distinction in short time. Using theory of Kuhn’s postulate, namely the paradigm shift in science. one can get roughly the distinction and its merging in terms of Habermas’ idea of discursive communication. This paper discusses the historical fact of medical scientific revolution, including the doubts raised by the members of medical scientific community and the final success of the “dissidents”, their efforts to get rid of the obstructions established by the scientific circles. Thus, it is worthy to study the theory and practice of the paradigm and its shift propounded by Thomas Kuhn. Key word Paradigm shift, helicobacter pylori, peptic ulcer, medical scientific revolution, gestalt switch.