Silly paper of the week

“Deconstructing the evidence-based discourse in health sciences: truth, power and fascism.”

That's a great title for a paper; really sets the mood for the reader. I've just finished reading through this scholarly masterpiece and wanted to offer some insight; my partner is a nursing student at the University of Ottawa, and familiar with the lead author.

First off, I'm told he's not the joking type. So rest assured, its not a Sokal-style spoof. The authors really do have an issue or two with evidence-based medicine (EBM); although having read the paper, its not absolutely clear what they would replace it with, or exactly why EBM is such a problem in health sciences. One is left guessing at what edifice should be raised in the place of EBM - what exactly do they want there? For the answer to that, my source on the inside tells me that there is a debate in nursing regarding the scientific validity of medical or health interventions which could not, for practical or ethical reasons, be set up with a control group. These situations are apparently very common. For example, one might set up a campaign to address a health issue that affects one community, but not find a true control group that adequately matched it. Still, the intervention goes ahead, but the results of the intervention, when reviewed and published, do not qualify for inclusion in the Cochrane database. The reason for that is Cochrane's exclusion criteria, where papers are hand-picked based on their evidentiary quality and robustness, achieved through the use of such artifices as control groups.

So, if practitioners, decision makers and funding bodies treat Cochrane as a gold standard, then certain branches of health sciences will lose out or be treated as a poor cousin to EBM, as they simply cannot reach the dizzying heights of the randomized, double blind, placebo controlled trials in the Cochrane database. It may well be this situation which the authors are challenging, although its rather hard to tell; the paper may not be a call to accord therapeutic touch the same status as hand washing in clinical practice.

On the other hand, it may be just that.

Having skim-read the paper (it's pretty gruelling stuff to actually read through) my suspicion is that the material that they ultimately want to protect is psychotherapy. Pomo theory is so riven with Freudian terms and concepts that to see it thrown on the scrap heap along with blood-letting and "humours" must really rankle its practitioners.

Why they think that invoking Deleuze and Guattari and the hilariously stupid term "microfascism" will be an institutionally effective blow against EBM, though is a question best left for them to answer.

I like the term "microfascism" though--it conjures up images of teeny-tiny hordes of jack-booted thugs scuttling about making the ants run on time--or something.

Pipirr said:

First off, I'm told he's not the joking type. So rest assured, its not a Sokal-style spoof.

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You don't think the wildly inappropriate recourse to Deleuze and Guttari might indicate otherwise?

I read the article and thought it was a put-on! It contradicts itself; by refuting proof and logic, there is no way to prove their own theory correct. If you can't prove yourself correct then there is no way you can refute charges that you are wrong. The same rules they are trying to misapply to science comes back and hits them in the face.

But proof is the problem! Wasn´t that the point of the article? Evidence-based medical practitioners insist on proof, thereby oppressing those that have none. Ergo, if you ask for proof, or have proof, you are a microfascist oppressor.

Its a Foucaltian viewpoint, apparently. Or just Deleuzional.

Mechbob said:

I read the article and thought it was a put-on! It contradicts itself...

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People have a surprisingly difficult time noticing contradictions in their thinking. It's like how people for centuries knew how selective breeding worked, but simultaneously thought that it was what the mother was thinking about at the moment of conception that determined many genetic traits (because the Bible said so). A blatant contradiction, but one that went unnoticed by the masses for many years.

You know, the only other thought I had about this paper was that maybe, just maybe, it was an attempt to do a Sokal from the other side: that is, to see if a bunch of humanities profs could fake a science journal into publishing a steaming pile of garbage?

God, I hope that is what it was...

Labeling a system of proof fascist just makes no sense to me. Facists set rules according to their whims in order to perpetuate a system where they stay in power. Fascism only makes sense as a concept with respect to individuals in power.

Can a system for admitting evidence be fascist? I cannot see how. Evidence gets in - even if it contradicts everything that has come before. The drug companies made millions from Pepsid and other antacids as a way of combatting ulcers. Then some guy proved that most ulcers were infections, gave people a six week course of antibiotics and the ulcers were gone. It hurt the drug companies. It hurt the feelings of powerful men who had spent their adult lives diagnosing ulcers. But it still came in.

If the current system allows for change, how in the honking heck is it fascist?

Pipirr said:

But proof is the problem! Wasn´t that the point of the article? Evidence-based medical practitioners insist on proof, thereby oppressing those that have none. Ergo, if you ask for proof, or have proof, you are a microfascist oppressor.

Its a Foucaltian viewpoint, apparently. Or just Deleuzional.

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This may be a semantic quibble, but I think it is an important one.

Proof is for mathematicians. We insist on evidence.

Gr8wight said:

This may be a semantic quibble, but I think it is an important one.

Proof is for mathematicians. We insist on evidence.

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Very true. I stand corrected.