Random reflections on science, art and technique applied to medicine and its evaluation

Science is aimed at universal knowledge. Art is aimed at action for solving concrete and local problems. Can medical practice therefore ever be a scie nce even when employing important aspects of scientific practice such as pr ecise concepts and vocabulary, and a demand for well-validated facts togeth er with rational reasoning? Evaluation of medical and clinical practices in general has an ambiguous status. According to the domain to be evaluated, it can reach a level of science in providing results of universal value but more often it is closer to art, the results remaining of local interest. T here is no strict correlation between the universal-local axis and the prac tical interest for public health. Epidemiologists should consider these mat ters very seriously and aim to contribute to, rather than discard, their si gnificance for the advancement of clinical practice.