Some of you might enjoy this absolute cracker from the current edition of the International Journal of Evidence-Based Healthcare: a critical theory deconstructionist attack on evidence based medicine and Cochrane centres, in a proper journal. Presumably I am a bit of a “microfascist” for posting it here.
Deconstructing the evidence-based discourse in health sciences: truth, power and fascism
Authors: Holmes, Dave; Murray, Stuart J1; Perron, AmÃ©lie2; Rail, GeneviÃ¨ve2
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.
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 â€“ that of post-positivism â€“ 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.
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 â€˜regimes of truthâ€™ 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.
critique, deconstruction, evidence-based, fascism, health sciences, power.
From their opening line (“We can already hear the objections. The term fascism represents an emotionally charged concept in both the political and religious arenas”) you can hear the authors relishing their own controversy, but amazingly, even that is not quite as annoying as the way they bang on about the Cochrane collaboration and hierarchies of knowledge, rather triumphantly, but without demonstrating that they understand the reasons why a good meta-analysis provides more compelling evidence than a good systematic review, which in turn provides more compelling evidence than an individual trial, and so on.
But they do peddle a good line in hyperbole. â€œThe classification of scientific evidence as proposed by the Cochrane Groupâ€¦ obeys a fascist logicâ€¦ This ‘regime of truth’ ostracises those with ‘deviant’ forms of knowledgeâ€¦ When the pluralism of free speech is extinguished, speech as such is no longer meaningful; what follows is terror, a totalitarian violence.â€
Archie Cochrane as a Captain with the International Brigade fighting Franco’s fascists in 1936
And this nonsense attacking EBM is not an isolated example, of course: the excellent journal Social Science and Medicine recently this paper on alternative therapies and evidence which, although not quite as absurd as Holmes above, does suggest there may be a growing movement. If you have any more examples, do please, always, send them my way, I’m going to start writing on this soon.
Anyway, excellent background and devastating critiques of this kind of fashionable nonsense can be found in the work of Levitt and Gross, and of course this whole scene met its match with the mighty Alan Sokal, a physicist who wrote a deliberately meaningless spoof postmodernist critique of physics, and then got it successfully published in “Social Text”, a leading journal in the field.
Since this is a slightly tricky journal to get hold of, I’ve pasted a few quotes below. Entirely unrepresentative quotes of course, selected just to make the authors look bad. No, hang it all, here’s the whole of their final section, if they want to be copyright fascists about it then let them come.
Critical intellectuals should work towards the creation of a
space of freedom (of thought), and as such, they constitute
a concrete threat to the current scientific order in EBHS and
the health sciences as a whole. It is fair to assert that the
critical intellectuals are at â€˜warâ€™ with those who have no
regards other than for an evidence-based logic. The war
metaphor speaks to the â€˜critical and theoretical revoltâ€™ that
is needed to disrupt and resist the fascist order of scientific
The evidence-based enterprise invented by the Cochrane
Group has captivated our thinking for too long, creating for
itself an enchanting image that reaches out to researchers
and scholars. However, in the name of efficiency, effectiveness
and convenience, it simplistically supplants all heterogeneous
thinking with a singular and totalising ideology.
The all-embracing economy of such ideology lends the
Cochrane Groupâ€™s disciples a profound sense of entitlement,
what they take as a universal right to control the scientific
agenda. By a so-called scientific consensus, this â€˜regime of
truthâ€™ ostracises those with â€˜deviantâ€™ forms of knowledge,
labelling them as rebels and rejecting their work as scientifically
unsound. This reminds us of a famous statement by
President George W Bush in light of the September 11
events: â€˜Either you are with us, or you are with the terroristsâ€™.
In the context of the EBM, this absolutely polarising world
view resonates vividly: embrace the EBHS or else be condemned
as recklessly non-scientific.
In conclusion, in The Human Condition, Hannah Arendt
points to one way to combat totalitarianism. For Arendt, the
opposite of totalitarianism is politics, by which she means,
politics guided by free speech and a plurality of views:
“speech is what makes man a political being. If we would follow
the advice, so frequently urged upon us, to adjust our cultural
attitudes to the present status of scientific achievement, we
would in all earnest adopt a way of life in which speech is no
longer meaningful.” (pp. 3â€“4)27
When the pluralism of free speech is extinguished, speech
as such is no longer meaningful; what follows is terror, a
totalitarian violence. We must resist the totalitarian program
â€“ a program that collapses words and things, a program that
thwarts all invention, a program that robs us of justice, of
our meaningful place in the world, and of the future that is
ours to forge together. Paradoxically, perhaps, an honest
plurality of voices will open up a space of freedom for the
radical singularity of individual and disparate knowledge(s).
The endeavour is always a risk, but such a risk is part of the
human condition, and it is that without which there could
be no human action and no science worthy of the name.
Plurality is the condition of human action because we are all the
same, that is, human, in such a way that nobody is ever the same
as anyone else who ever lived, lives, or will live.
Is it just me, or does all this talk of fascists remind you, ever so slightly, of Rik Mayall in the Young Ones?
Professor David Colquhoun (FRS), the excellently entertaining microfascist (sorry David…) who runs this ever vigilant page on quackery, has very kindly suggested that you might read the full paper here, and reminded me of this other recent gem in a similar vein.
There are also some more great examples in the comments below, including this.
(And if that had you shaking with laughter in your jackboots, you might also enjoy this mystery tale of Agatha-Christie-related postmodernist bollocks on science (or indeed this strange tale involving artificial intelligence, New Scientist, the Loebner Prize, and the Nazis (or indeed this))).