Thursday, July 3, 2008

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

ResearchBlogging.orgLet me not mince words. This is the most egregious bullsh*t(1) I've ever read in a peer-reviewed journal. It claims that "the evidence-based movement in the health sciences is outrageously exclusionary and dangerously normative with regards to scientific knowledge" and that "scholars have not only a scientific duty, but also an ethical obligation to deconstruct" this dominant, "fascist", movement.

Ben Goldacre picked it up a while ago. (There's also a lively comment thread.) The paper dates from 2006, so there's probably more criticism on there on the tubes too.

Before saying something about what's up, here's the abstract, in full, so you can see clearly that I'm not trying to make these bozos out to be madder than they are:

Background Drawing on the work of the late French philosophers Deleuze and Guattari, the objective of this paper is to demonstrate that the evidence-based movement in the health sciences is outrageously exclusionary and dangerously normative with regards to scientific knowledge. As such, we assert that the evidence-based movement in health sciences constitutes a good example of microfascism at play in the contemporary scientific arena.
Objective The philosophical work of Deleuze and Guattari proves to be useful in showing how health sciences are colonised (territorialised) by an all-encompassing scientific research paradigm -- that of post-positivism -- but also and foremost in showing the process by which a dominant ideology comes to exclude alternative forms of knowledge, therefore acting as a fascist structure.
Conclusion The Cochrane Group, among others, has created a hierarchy that has been endorsed by many academic institutions, and that serves to (re)produce the exclusion of certain forms of research. Because ‘regimes of truth’ such as the evidence-based movement currently enjoy a privileged status, scholars have not only a scientific duty, but also an ethical obligation to deconstruct these regimes of power.
Key words: critique, deconstruction, evidence-based, fascism, health sciences, power.

Whew.

At least they say that they're going to "demonstrate" something. So there's going to be an argument, right - they'll give reasons, maybe some evidence. Let's see.

The first section of the article headed 'Introduction' is just scene setting - a longer version of the abstract with some name-dropping and some yelling, and bald insistence on draining the word fascist of all discriminating content, so that 'fascist'(2) turns out to mean just 'dominant' and 'exclusionary'. No argument here.

The second section starts with a paragraph describing(3) 'EHBS' (evidence-based health sciences). The authors give zero indication of understanding the reasons for the evidence-based approach, of properly used statistics, the need for control groups, the point of randomization, etc.

The second paragraph begins:
"At first glance, EBHS seems beneficial for positive patient outcomes, which is a primary healthcare objective."
WTF!?
  • Why "At first glance"? What the hell have glances got to do with anything here, when you're talking about efficacy study design, data analysis, etc.? Makes no sense at all unless you see that this is just more rhetoric. They're implying that EBHS only seems like a good idea superfically.
  • And notice the "seems". Why say "seems" when you've just pretended to give a description of the case for the evidence-based approach? Why not either acknowledge the case, or give reasons against it?
They continue:
"As a consequence, it is easy for healthcare researchers and clinicians to assume that EBHS is the method to assure that patients receive optimal care."
  • "Assume"? Why not "recognise on the basis of good reasons relating to what counts as evidence for efficacy"?
  • So a key part of the plot should be pretty clear by now. They persistently fail to acknowledge the arguments in favour of EBHS, or to give a fair description of EBHS. Then, they insinuate that supporters of EBHS are the ones guilty of superficiality, for believing things "at first glance" etc.
The other main ingredients here are:
  • A bunch of name calling ('fascist', etc.).
  • Some mis-representations of the work of certain French philosophers.
  • More preposterous non-sequiturs and pastiches of arguments.
Two more examples picked more or less at random:
  • We're told portentously that deconstruction is "notoriously difficult to define because it's a practice, and not a fixed concept" as though it's a generally recognised truism that practices (like nose-picking) are that much harder to define than concepts (like the concept of a surreal number). Uh, sure, that seems like the sort of thing that would be convincing at first glace to a group of lazy twerps passing of drivel as scholarship.
  • We're told that people who care about "evidence" maintain a "Newtonian, mechanistic world view". Cool. That'll explain why there's no evidence for anything non-Newtonian in the universe like, uh...

I'm sorry. I can't write any more about this. It's too annoying. I re-read the whole text carefully looking carefully for a paragraph that contained an argument that seemed worth taking seriously, or that showed any genuine appreciation of the fact that there are arguments in favour of the key features of EHBC, or that made a single scientific, historical or philosophical claim that did immediately make me think of two or three immediate criticisms based on general knowledge. Nada. This is bullshit of the first water. If you already thought evidence mattered, you'll get no reason to change your mind here, because there's no argument. If you didn't care about evidence, there's no point reasoning with you. Maybe if you had a bird-cage that needed a new floor-lining...

There may be worse, though. For now I'm too scared to look properly.

Endnotes:

(1) In the sense of Harry Frankfurt.

(2) Goldacre shows a picture of Cochrane himself taken during the Spanish Civil War, where he was among other internationals fighting against ... er ... the Fascists. We should not complain too loudly - there's probably another paper forthcoming arguing that anyone who thinks that evidence matters in any area at all, including what counts as fascism, is a fascist.

(3) Not just describing - there's some undermining by rhetoric through use of constructions like "are believed" and "is deemed" in place of acknowledging that there are arguments in favour of a certain position. It is believed that this sort of strategy of undermining by insinuation is especially popular among weasels and cloth-eared constructivist bottom feeders.

Holmes, D., Murray, S.J., Perron, A., Rail, G. (2006). Deconstructing the evidence-based discourse in health sciences: truth, power and fascism. International Journal of Evidence-Based Healthcare, 4(3), 180-186. DOI: 10.1111/j.1479-6988.2006.00041.x

6 comments:

Doctor Spurt said...

Among the other write ups of this, see:

James Randi: http://www.randi.org/jr/2006-08/081806silly.html

Trevor Butterworth on stats. org: http://stats.org/stories/2006/medicine_fascist_aug21_06.htm

and Butterflies and wheels: http://www.butterfliesandwheels.com/notesarchive.php?id=1508

Michael Meadon said...

Excellent stuff. I'm glad you blogged it, because I've tried and tried to read that damn paper, and I just can't finish it.

Michael Meadon said...

By the way, have you castigated the editors of the journal and/or the authors via email? It could be fun and a decent follow-up post...

Michael Meadon said...

Ahhhh... I just noticed these freaks are *nurses*. That explains a lot, actually.

Michael Meadon said...

Ok, I really should try and comment only once, but wow. Have a look at THIS: http://www.ncbi.nlm.nih.gov/pubmed/17683287

Check out the lead author's website: http://www.health.uottawa.ca/profiles/dholmes.htm. Looking at his publications makes me want to scream. Why does he get published?!?!?!?! (I note he hasn't been published in any decent journals, just bollocksy nurse journals)

Doctor Spurt said...

Dude, there's only so much I can take on. It will be months before I can look at another of those papers in the detail required to blag it responsibly. (You know, being one of the evidence-fascists means I have to do some actual work before I call this stuff rubbish, which is not a standard they demand from themselves.)