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Resumo

This paper examines the explanatory value of Fleck's conceptual analysis with regard to the development of medical knowledge. The discussion is illustrated by empirical data gathered as part of an on‐going study into Repetitive Strain Injury (RSI), a condition currently disputed within medical circles. Whilst there is empirical substantiation for some of Fleck's beliefs, the findings suggest his notion that general practitioners are educated and patients uneducated is too simplistic; in particular circumstances these attributes may be reversed. Furthermore, there is little evidence to show that ideas are circulated and exchanged between specialists, GPs and a lay audience; according to this revised view, medical knowledge is determined by experts alone. By invoking an extended version of Collins' notion of the 'core‐set', the paper considers how seemingly marginal actors can exploit their technical competence and thus play an influential role in medical debate.

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