Editorial Paradigms, emperor’s clothes syndrome, and hidden curriculum: how do they affect joint, bone, and spine diseases? Keywords: Paradigm; Emperor’s clothes syndrome; Curriculum; Hidden curriculum; Ethics 1. Paradigm “Paradigm” is derived from a Greek word meaning “model” or “example”, which in turn comes from a verb that means “to show”. As a mental construct, a paradigm is an accepted rule that is interiorized as the norm by a scientific community at a point of its history. This norm delimits fields—and questions pertaining to those fields—that the scientific community deems worthy of investigation. Philosophers, such as the epistemolo- gist and science historian Thomas Samuel Kuhn, define “para- digm” as an exemplar, a model worthy of imitation because it illustrates a rule. A paradigm is accepted by a scientific com- munity that is defined by specific group activities, for instance conventions, lectures, and publications. Several paradigms per- taining to the same topic may co-exist at a given point in time, occasionally conflicting with, or ignoring, each other. Similar to all theories, a paradigm must face the test of time. New knowledge may refute a paradigm that was securely anchored in the scientific mind. However, Karl Popper pointed out that a paradigm shown to be wrong is not discarded until another paradigm emerges to take its place. Continued use of paradigms that are known to be wrong was described by Gross [1] under the name “emperor’s clothes syndrome”. The emperor (see below) does not admit that he is naked until he is wrapped in a heavy mantle. Thus, a paradigm reflects the role for the cultural environment in making a sign acceptable, irrespective of whether the sign is true or false. Elevating a false sign to the rank of paradigm, and therefore dogma, has consequences that may range from negligible to devastating. 2. Emperor’s clothes syndrome Emperor’s clothes syndrome, described by Gross [1], takes its name from the well-known tale by Hans Christian Andersen (1835). In the story, two swindlers tell an emperor they can weave uncommonly fine fabric that is invisible to people who are stupid or unfit for their office. Of course, no such fabric exists. The emperor asks the two men to weave fabric for a suit then sends his minister to assess their progress. The min- ister is unwilling to admit that he can see no fabric, as he feels he is intelligent and fit for his office. He therefore reports to the emperor that the fabric is magnificent. The emperor has the same behavior when he goes to see for himself. The two swindlers are told to use the fabric for a suit that the emperor will wear to lead a procession. They pretend to dress him in the new clothes, the whole retinue praises the suit, and the proces- sion begins. After a while, a child in the crowd exclaims: “But he has nothing on!” The emperor knows that the child is right but nevertheless finishes the procession. The tale by Andersen could be transposed as follows: a pro- minent physician (the emperor) finds a clinical sign (the suit), and his attendants (the retinue) agree. However, the sign does not exist: the emperor has nothing on. In Andersen’s tale, the emperor continues to pretend that his suit is magnificent, even after he knows that there is no suit at all. This phenomenon was described by Karl Popper more than a century later. In the story, the paradigm “invisible but real suit” is accepted by the retinue and emperor. The paradigm collapses when an innocent child cries “He has nothing on!” but the emperor (and therefore his retinue) continue the pretense (probably until he obtains another suit) and walks on, clothed in his own dignity. 3. The hidden curriculum The term “hidden curriculum” is used to designate the unin- tended transmission of beliefs and behaviors, as opposed to the intentional teaching of knowledge and skills. The hidden curri- http://france.elsevier.com/direct/BONSOI/ Joint Bone Spine 73 (2006) 581–583 1297-319X/$ - see front matter © 2006 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.jbspin.2006.02.007