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

August 11th, 2006 by Ben Goldacre in bad science, postmodernist bollocks | 86 Comments »

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, Amélie2; Rail, Geneviève2

Source: International Journal of Evidence-based Healthcare, Volume 4, Number 3, September 2006, pp. 180-186(7)

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.

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. “The classification of scientific evidence as proposed by the Cochrane Group… obeys a fascist logic… This ‘regime of truth’ ostracises those with ‘deviant’ forms of knowledge… When the pluralism of free speech is extinguished, speech as such is no longer meaningful; what follows is terror, a totalitarian violence.”


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.


Final remarks

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 ‘war’ with those who have no
regards other than for an evidence-based logic. The war
metaphor speaks to the ‘critical and theoretical revolt’ that
is needed to disrupt and resist the fascist order of scientific
knowledge development.
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 Group’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 ‘regime of
truth’ ostracises those with ‘deviant’ 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: ‘Either you are with us, or you are with the terrorists’.
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. 3–4)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
– 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?



Update:

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))).


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86 Responses



  1. ceec said,

    August 11, 2006 at 3:29 pm

    Far be it from me to get deconstructionist on your ass, but there’s nothing inherently better about a meta-analysis than a single study. Meta-analyses can be a load of old cobblers, depending on who’s doing them, what they include etc., but they are sometimes treated as if they are the holy ghost itself.

    Not saying this paper isn’t on the bonkers side, mind you…

  2. curlyfries said,

    August 11, 2006 at 3:50 pm

    The entire Sokal paper, along with his comments on the affair, can be found on his website at www.physics.nyu.edu/faculty/sokal/

  3. yonatron said,

    August 11, 2006 at 3:51 pm

    Wait a minute, this paper isn’t supposed to be a funny joke?

  4. coracle said,

    August 11, 2006 at 4:11 pm

    What does ‘dangerously normative’ mean with regard to scientific knowledge? That it does tend towards a normal distribution and that’s a bad thing? What distribution should it have instead?

  5. ceec said,

    August 11, 2006 at 4:40 pm

    By the way, here is one scientific view of Oswald Schwarz (1949) “The Psychology of Sex” which I happen to have to hand and have opened more or less randomly

    “a woman may forgive many things, but she is implacable when she feels that the female in her is slighted: if, for instance a man does not notice or deliberately ignores the fact that she desires him sexually, or wears a new hat” p.138

    If it’s not totalitarian fascist to fail to notice a lady’s new hat, I don’t know what is.

  6. lexmith said,

    August 11, 2006 at 4:42 pm

    What I find galling is the fact that they are just spewing opinions without any evidence…

    BTW would it be a fascist idea to include your objectives under the ‘objectives’ heading?

  7. David Colquhoun said,

    August 11, 2006 at 4:46 pm

    Oh my gawd, This one is even worse than Christine Barry’s stuff that I posted a while ago (www.ucl.ac.uk/Pharmacology/dc-bits/quack.html#barry1), with comparison with Sokal’s spoof (www.ucl.ac.uk/Pharmacology/dc-bits/quack.html#sokal11) and his wonderful essay on ” Pseudoscience and Postmodernism: Antagonists or Fellow-Travelers?.
    If you can bear to read the whole text, get it at www.ucl.ac.uk/Pharmacology/dc-bits/quack.html#holmes1

  8. WordsWantToBeFree said,

    August 11, 2006 at 5:46 pm

    Here’s the full paper. Fill your boots, and scroll down if you can’t bear it.

    doi:10.1111/j.1479-6988.2006.00041.x Int J Evid Based Healthc 2006; 4: 180–186
    © 2006 The Authors
    Journal Compilation © Blackwell Publishing Asia Pty Ltd
    Blackwell Publishing AsiaMelbourne, AustraliaJBRInternational Journal of Evidence-Based Healthcare1479-697X© 2006 The Authors; Journal Compilation © Blackwell Publishing Asia Pty Ltd? 200643180186Original ArticleDeconstructing the evidence-based discourseD Holmes
    et al.
    Correspondence: Associate
    Professor Dave Holmes, Faculty
    of Health Sciences, School of
    Nursing, University of Ottawa,
    451 Smyth Road, Ottawa, ON,
    KIH OM5, Canada. Email:
    dholmes@uottawa.ca
    S C H O L A R L Y A R T I C L E
    Deconstructing the evidence-based
    discourse in health sciences: truth,
    power and fascism
    Dave Holmes RN PhD,1 Stuart J Murray PhD,2 Amélie Perron RN
    PhD(cand)1 and Geneviève Rail PhD1
    1Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, and 2Department of English,
    Ryerson University Toronto, Ontario, Canada
    Abstract
    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.
    Introduction
    We can already hear the objections. The term fascism represents
    an emotionally charged concept in both the political
    and religious arenas; it is the ugliest expression of life in the
    20th century. Although it is associated with specific political
    systems, this fascism of the masses, as was practised by Hitler
    and Mussolini, has today been replaced by a system of
    microfascisms – polymorphous intolerances that are
    revealed in more subtle ways. Consequently, although the
    majority of the current manifestations of fascism are less
    brutal, they are nevertheless more pernicious. We believe
    Deconstructing the evidence-based discourse 181
    © 2006 The Authors
    Journal Compilation © Blackwell Publishing Asia Pty Ltd
    that fascism is a concept that is not associated with any
    particular person or location. Therefore, we will use this term
    as defined by Deleuze and Guattari,1 and now used by a
    number of contemporary authors.
    Within the healthcare disciplines, a powerful evidencebased
    discourse has produced a plethora of correlates, such
    as specialised journals and best practice guidelines. Obediently
    following this trend, many health sciences scholars
    have leapt onto the bandwagon, mimicking their medical
    colleagues by saturating health sciences discourses with
    concepts informed by this evidence-based movement.2 In
    the words of Michel Foucault, these discourses represent
    an awesome, but oftentimes cryptic, political power that
    ‘work[s] to incite, reinforce, control, monitor, optimize, and
    organize the forces under it’ (p. 136).3 Unmasking the hidden
    politics of evidence-based discourse is paramount, and
    it is this task that forms the basis of our critique.
    Drawing in part on the work of the late French philosophers
    Deleuze and Guattari,1,4 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 Guattari1 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.
    Evidence-based health sciences: definition
    and deconstruction
    As a global term, EBHS (evidence-based health sciences)
    reflects clinical practice based on scientific inquiry. The
    premise is that if healthcare professionals perform an action,
    there should be evidence that the action will produce the
    desired outcomes. These outcomes are desirable because
    they are believed to be beneficial to patients.5 Evidencebased
    practice derives from the work of Archie Cochrane,
    who argued for randomised controlled trials (RCTs being the
    highest level of evidences) as a means of ensuring healthcare
    cost containment, among other reasons.6 In 1993, the
    Cochrane Collaboration, serving as an international research
    review board, was founded to provide clinicians with a
    resource aimed at increasing clinician–patient interaction
    time by facilitating clinicians’ access to valid research.2 The
    Cochrane database was established to provide this resource,
    and it comprises a collection of articles that have been
    selected according to specific criteria.7 For example, one of
    the requirements of the Cochrane database is that acceptable
    research must be based on the RCT design; all other
    research, which constitutes 98% of the literature, is deemed
    scientifically imperfect.6
    At first glance, EBHS seems beneficial for positive patient
    outcomes, which is a primary healthcare objective.8 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.9 While EBHS does acknowledge
    that healthcare professionals possess discrete bodies of
    knowledge, EBHS advocates defend its rigid approach by
    rationalising that the process is not self-serving because
    improved healthcare and increased healthcare funding will
    improve patient outcomes.2,7,10
    Consequently, EBHS comes to be widely considered as the
    truth. 9 When only one method of knowledge production is
    promoted and validated, the implication is that health sciences
    are gradually reduced to EBHS. Indeed, the legitimacy
    of health sciences knowledge that is not based on specific
    research designs comes to be questioned, if not dismissed
    altogether. In the starkest terms, we are currently witnessing
    the health sciences engaged in a strange process of eliminating
    some ways of knowing. EBHS becomes a ‘regime of
    truth’, as Foucault would say – a regimented and institutionalised
    version of ‘truth’.
    The health sciences take their lead from institutional
    medicine, whose authority is rarely challenged or tested
    probably because it alone controls the terms by which
    any challenge or test would proceed. Once it was
    adopted by medicine, the health sciences accepted RCTs
    as the gold standard of evidence-based knowledge. It is
    deeply questionable whether EBHS, as a reflection of stratification
    and segmentation, promotes the multiple ways of
    knowing deemed important within most health disciplines.
    Moreover, we must ask whether EBHS serves a
    state or governmental function, where ready-made and
    convenient ‘goals-and-targets’ can be used to justify cuts
    to healthcare funding.6 We believe that health sciences
    ought to promote pluralism – the acceptance of multiple
    points of view.2 However, EBHS does not allow pluralism,
    unless that pluralism is engineered by the Cochrane
    hierarchy itself.7 Such a hegemony makes inevitable the
    further ‘segmentation’ of knowledge (i.e. disallowing multiple
    epistemologies), and further marginalise many forms
    of knowing/knowledge. Importantly, the evidence-based
    182 D Holmes et al.
    © 2006 The Authors
    Journal Compilation © Blackwell Publishing Asia Pty Ltd
    movement is neither ‘progressive’ nor a ‘natural’ development
    in health sciences: it is a trend that is engineered.
    As a response to this, a vigilant resistance must arise from
    within the health disciplines themselves, and one way of
    deploying such resistance is by using a tool called ‘deconstruction’.
    Drawing on the work of the late French philosopher,
    Jacques Derrida, deconstruction is notoriously difficult to
    define because it is a practice, and not a fixed concept
    based on abstract ‘facts’ or ‘evidence’. For our purposes,
    we might say that it is the critical practice of exposing the
    foundations that underpin the apparent truth-value of a
    certain concept or idea, challenging the way that it
    appears to us as self-evidently or ‘naturally’ so. In the
    words of one of Derrida’s early translators, the task of
    deconstruction is ‘to locate and “take apart” those concepts
    which serve as axioms or rules for a period of
    thought’.11 More precisely, deconstruction works to demonstrate
    how concepts or ideas are contingent upon historical,
    linguistic, social and political discourses, to name
    but a few. We deconstruct our taken-for-granted ‘truths’
    by attending to how they came to be constructed in the
    first place. One method is to critically analyse the sets of
    binary oppositions that have informed the history of Western
    thought, for example, mind versus body. While each
    term is implicit in the definition of the other (suggesting
    they are not utterly discrete), Derrida argues that within
    such binaries, one term is always privileged at the expense
    of the other. Here, we might think of mind over body
    (matter), but to these we might add sets of correlative
    terms – essentially hierarchies – such as reason over emotion,
    male over female, logic over myth or even quantitative
    measure over qualitative measure. In the name of a
    justice-to-come, deconstruction looks towards the future
    by interrogating the hierarchical power that operates at
    the heart of these binaries.
    Thus, implicit in deconstruction is a suspicion of the essentialist
    and hierarchical nature of institutional knowledge. In
    a deconstructive vein, we must ask not only, ‘What constitutes
    evidence?’ but also, what is the ‘regime of truth’ (Kuhn
    would call this a ‘paradigm’ and Foucault an ‘épistèmé’) that
    dictates when or how one piece of evidence shall count as
    evidence, while another is denigrated or excluded altogether?
    In other words, what makes one piece of evidence
    so ‘self-evidently’ meaningful for us at this precise historical
    moment, while another appears so ‘self-evidently’ meaningless
    or nonsensical? Attending to this internal logic of exclusion
    is both democratising and, arguably, it is just better
    science! It is not insignificant that the word ‘evidence’ contains
    the Latin root videre, which means ‘to see’. The etymology
    of the term itself suggests a visual bias that still holds
    sway in the ‘enlightened’ empirical sciences today.12,13 But
    we might ask: what is the fate of that evidence that is
    invisible to us – invisible, and yet still marginally felt and
    attested to?
    Unmapping health sciences
    It is becoming increasingly evident that an unvarying, uniform
    language – an ossifying discourse – is being mandated
    in a number of faculties of health sciences where the dominant
    paradigm of EBHS has achieved hegemony.14 This
    makes it difficult for scholars to express new and different
    ideas in an intellectual circle where normalisation and standardisation
    are privileged in the development of knowledge.
    The critical individual must then resort to resistance strategies
    in front of such hegemonic discourses within which
    there is little freedom for expressing unconventional
    thoughts.
    Rather than risk being alienated from their colleagues,
    many scientists find themselves interpellated by hegemonic
    discourses and come to disregard all others. Unfortunately,
    privileging a single discourse (evidence-based medicine
    (EBM)) situated within a single scientific paradigm (postpositivism)
    confines the researcher to a yoke of exactly
    reproducing the established order. To a large degree, the
    dominant discourse represents the ladder of success in academic
    and research milieus where it establishes itself as a
    weapon used against those who praise the freedom of scientific
    inquiry and the free debate of ideas. When only one
    discursive formation (EBM) finds itself on the discursive terrain
    (health sciences), academics and researchers constitute
    a united community whose ways of speaking and thinking
    thwart both creativity and plurality in the name of efficiency
    and effectiveness.
    We believe that EBM, which saturates health sciences discourses,
    constitutes an ossified language that maps the landscape
    of the professional disciplines as a whole. Accordingly,
    we believe that a postmodernist critique of this prevailing
    mode of thinking is indispensable. Those who are wedded
    to the idea of ‘evidence’ in the health sciences maintain
    what is essentially a Newtonian, mechanistic world view:
    they tend to believe that reality is objective, which is to say
    that it exists, ‘out there’, absolutely independent of the
    human observer, and of the observer’s intentions and observations.
    They fondly point to ‘facts’, while they are forced
    to dismiss ‘values’ as somehow unscientific. For them, this
    reality (an ensemble of facts) corresponds to an objectively
    Deconstructing the evidence-based discourse 183
    © 2006 The Authors
    Journal Compilation © Blackwell Publishing Asia Pty Ltd
    real and mechanical world. But this form of empiricism, we
    would argue, fetishises the object at the expense of the
    human subject, for whom this world has a vital significance
    and meaning in the first place. An evidence-based, empirical
    world view is dangerously reductive insofar as it negates the
    personal and interpersonal significance and meaning of a
    world that is first and foremost a relational world, and not
    a fixed set of objects, partes extra partes.
    Of course, we do not wish to deny the material and
    objective existence of the world, but would suggest, rather,
    that our relation to the world and to others is always mediated,
    never direct or wholly transparent. Indeed, the sociocultural
    forms of this mediation would play a large part in
    the way the world appears as full of significance. Empirical
    facts alone are quantities that eclipse our qualitative and
    vital being-in-the-world. For example, how should a woman
    assign meaning to the diagnosis she just received that,
    genetically, she has a 40% probability of developing breast
    cancer in her lifetime? What will this number mean in real
    terms, when she is asked to evaluate the meaning of such
    personal risk in the context of her entire life, a life whose
    value and duration are themselves impossible factors in the
    equation?15–18
    From a variety of perspectives, those we label as ‘postmodern
    authors’ offer a robust critique of evidence-based
    health sciences and their objectivist world view. The French
    philosopher Jean-François Lyotard sees postmodernism
    as the end of universal or ‘meta-narratives [grands récits]’
    that characterise the totalising Reason of Modernity.19 In
    broad strokes, postmodern authors provide a critique of
    the knowing subject, who is alleged to be a contextless,
    abstract and autonomous ego, implicitly male, white, Western
    and heterosexual. The clinician can often be considered
    such an institutional subject who is presumed both to know
    the truth of disease and to have the moral and intellectual
    authority to prescribe treatment. Foucault, for one, is critical
    of this power, which he describes with the metaphor of
    the ‘clinical gaze’ – a panoptic kind of ‘expert seeing’ that
    both determines in advance what will appear, and, more
    ominously, what will be silently internalised by the patient,
    and will govern his or her own inner experience and significant
    values. ‘That which is not on the scale of the gaze’,
    Foucault writes, ‘falls outside the domain of possible knowledge’
    (p. 166).12 Thus, the authority of the clinician must
    be understood as a discursive power that shapes the realm
    of the possible and, in doing so, often ignores certain
    symptoms that would allow a more appropriate diagnosis.
    At the same time, the absolute authority of the gaze
    becomes the manner in which the patient will see him- or
    herself. Obvious examples here are the hysterisation of the
    female body and the pathologisation of homosexuality
    within medical discourse. In the face of such phenomena
    being now widely regarded as social/medical constructions,
    we might have hoped that health sciences would become
    more critical of its authority and the process through which
    it re/produces modern binaries (e.g. normal/pathological,
    male/female).
    A starting point for health sciences would be to promote
    the multiplicity of what Foucault describes as subjugated
    forms of knowledge (savoirs assujettis): these forms of knowledge
    are ways of understanding the world that are ‘disqualified
    as non-conceptual knowledges, as insufficiently
    elaborated knowledges: naïve knowledges, hierarchically
    inferior knowledges, [and] knowledges that are below the
    required level of erudition or scientificity’ (p. 7).20 These
    forms of knowledge arise from below, as it were, in contradistinction
    to the top-down approach that characterises the
    hegemonic thrust of EBHS. For Foucault, a subjugated
    knowledge is not the same thing as ‘common sense’.
    Instead, it is ‘a particular knowledge, a knowledge that is
    local, regional, or differential’ (pp. 7–8).20
    In our view, this positive process begins with a critique of
    EBHS and its hegemonic norms. As we have argued, according
    to postmodern authors, these norms institute a hidden
    political agenda through the very language and technologies
    deployed in the name of ‘truth’. Again, Foucault sums
    up this position in his critique of modern medicine: ‘Medicine,
    as a general technique of health even more than as a
    service to the sick or an art of cures, assumes an increasingly
    important place in the administrative system and the
    machinery of power’ (p. 176).21 Here, in such an ‘administrative
    system’ and a ‘machinery of power’, we find a classic
    allusion to what Hannah Arendt defines as totalitarianism or
    fascism, as we defined it earlier. For her, somewhat optimistically,
    totalitarian regimes are not the simple result of an
    innate evil in humankind; rather, totalitarianism is a political
    phenomenon that emerges from a confluence of socio-historical
    forces. She writes that 20th century totalitarianism is
    essentially an ideology that arose to fill a political vacuum
    in post-World War I Europe, when positive laws increasingly
    came to be replaced by terror.22
    Arendt herself draws the link between totalitarian ideology
    and the modern sciences, and so we are justified to turn to
    her, among others, to find a trenchant critique of EBHS. The
    ‘regime of truth’ that has emerged from the EBM is an
    ideology that is supported by a number of contingent factors
    – contingencies that EBHS would mistakenly classify as
    ‘truths’. An ideology is monolithic: those who adhere to
    184 D Holmes et al.
    © 2006 The Authors
    Journal Compilation © Blackwell Publishing Asia Pty Ltd
    the ideology believe it ‘can explain everything and every
    occurence [sic] by deducing it from a single premise’
    (p. 468).22 She warns that totalitarianism ‘is quite prepared
    to sacrifice everybody’s vital immediate interests to the execution
    of what it assume[s] to be the law of History or the
    law of Nature’ (pp. 461–462).22 But, as we have remarked,
    History and Nature are made; these forms therefore call for
    an ever-renewed critique.
    Fascism and the fall of thought
    The ossifying discourse that supports EBM is the result of an
    ideology that has been promoted to the rank of an immutable
    truth and is considered, in learned circles, as essential
    to real science. We could add here that its ossified language
    is a method of communicating in coded form, in stereotyped
    and dogmatic phraseology – an ideological message
    that will not be contradicted or challenged by its authors,
    but will always be understood by initiates.23 In this way, in
    its capacity as an ossifying discourse, the term ‘evidencebased
    movement’ (including concepts associated with it)
    sustains itself with its lexicon of acceptable ideas and forms.
    In his famous novel 1984, George Orwell coined the term
    Newspeak to describe a revised language purged from any
    affective tone. Newspeak, the ‘official language’ of the fictional
    Oceania, is extraordinary in that its lexicon decreases
    every year – ostensibly in the name of efficiency and effectiveness.
    As the character Syme puts it:
    Of course the great wastage is in the verbs and adjectives, but
    there are hundreds of nouns that can be got rid of as well. . . . If
    you have a word like ‘good’, what need is there for a word like
    ‘bad’? ‘Ungood’ will do just as well. . . . Or again, if you want a
    stronger version of ‘good’, what sense is there in having a whole
    string of vague useless words like ‘excellent’ and ‘splendid’ and
    all the rest of them? ‘Plusgood’ covers the meaning, or ‘doubleplusgood’
    if you want something stronger still. . . . In the end the
    whole notion of goodness and badness will be covered by only
    six words – in reality, only one word. (pp. 45–46)24
    Newspeak may be efficient, but in the ‘destruction of words’
    it also operates to radically restrict the ways in which
    humans are mediated with their world and with others. The
    totalitarian regime governing Oceania understands that
    complex – or pluralistic – languages would pose a threat to
    its security, and so the true goal of Newspeak is to take away
    the ability to conceptualise revolution adequately, or even
    to conceive of the terms by which such a resistance might
    emerge. According to Oceania’s state manual, available only
    to elite Party members and entitled ‘The Theory and Practice
    of Oligarchical Collectivism’:
    The masses never revolt of their own accord, and they never
    revolt merely because they are oppressed. Indeed, so long as they
    are not permitted to have standards of comparison they never
    even become aware that they are oppressed. (p. 171)24
    We argued above in terms that resonate immediately with
    Orwell’s totalitarian vision: The EBHS seldom question the
    authority of their own discourses, but deploy them unknowingly
    – they risk becoming the servo-mechanism of their
    own technology, unable to conceptualise the terms that
    would lead them to think outside this narrow world view.
    And indeed, why should they, when they can enjoy institutional
    promotions and accolades, public recognition and
    state contracts of all kinds? EBM and its related concepts are
    highly promoted in academic spheres, so much so that a
    research article free from these taken-for-granted concepts
    risks being labelled as scientifically unsound. Applying the
    work of Orwell in a critique of EBM in health sciences might
    surprise the reader; however, after an in-depth reading of
    1984, we feel that Orwell’s vision is gradually becoming a
    reality. Currently, a large number of scholars in the health
    sciences follow their colleagues in medicine down a narrow
    path leading to uniformity and intolerance. There is therefore
    in our opinion, the creation and advancement of a new
    ‘language’ that is supplanting all others, attempting to discredit
    or to eliminate them from the discursive terrain of
    health. This is scientific Newspeak. It is a highly normative
    and recalcitrant scientific language that stands in opposition
    to that sense of hope that sustains every freedom-loving
    individual.
    The mastery of scientific Newspeak is, for the most part,
    a regurgitation of prefabricated formulas (buzz words or
    catch words) that is informed by a single, powerful lexicon.
    This new guide book of scientific vocabulary, including
    terms connected with EBM (e.g. systematic literature review,
    knowledge transfer, best practices, champions, etc.), is taken
    seriously in the realm of health sciences, so much so that it
    is considered vital as a reflection of ‘real science’. The classification
    of scientific evidence as proposed by the Cochrane
    Group thus constitutes not only a powerful mechanism of
    exclusion for some types of knowledge, it also acts as an
    organising structure for knowledge and a mechanism of
    ideological reinforcement for the dominant scientific paradigm.
    In that sense, it obeys a fascist logic.
    Along with Deleuze and Guattari,1 we understand such
    fascist logic as a desire to order, hierarchise, control, repress,
    direct and impose limits. Fascism is one of the many faces
    of totalitarianism – the total subjection of humanity to the
    political imperatives of systems whose concerns are of their
    own production.25 In light of our argument, fascism is not
    too strong a word because the exclusion of knowledge
    ensembles relies on a process that is saturated by ideology
    Deconstructing the evidence-based discourse 185
    © 2006 The Authors
    Journal Compilation © Blackwell Publishing Asia Pty Ltd
    and intolerance regarding other ways of knowing. The process
    at play here is one that operates hand-in-hand with
    powerful political or ‘power’ structures and that gears and
    sustains scientific assertions in the same direction: that of
    the dominant ideology. Unfortunately, the nature of this
    scientific fascism makes it attractive to all of us – the subjected.
    In Foucault’s words:
    the major enemy, the strategic adversary is fascism. . . . And not
    only historical fascism, the fascism of Hitler and Mussolini – which
    was able to mobilize and use the desire of the masses so effectively
    – but also the fascism in us all, in our heads and in our
    everyday behavior, the fascism that causes us to love power, to
    desire the very thing that dominates and exploits us. (p. xiii)1
    Fascism does not originate solely from the outside; it is
    a will within us to desire, although often unwittingly, a life
    of domination.1 Such a ‘lovable’ fascism requires little more
    than the promise of success (grants, publications, awards,
    recognition, etc.) within its system to get us to participate
    wholeheartedly.25 Perhaps it is time to think about governing
    structures that impose their imperatives (academic, scientific,
    political, economic) on academics and researchers, and
    to ask ourselves what drives us to love fascist and exclusionary
    structures.
    The Cochrane Group has created a hierarchy that has
    been endorsed by many academic institutions, and that
    serves to (re)produce the exclusion of certain forms of
    knowledge production. Because EBM, as a ‘regime of truth’,
    currently enjoys a privileged status, there exists a scientific
    and ethical obligation to deconstruct such regime. Given the
    privileged relation to knowledge defining the intellectual
    mission, intellectuals are well located to deconstruct the
    ‘truth’ and to ‘speak truth to power’, to use Foucault’s
    expression. Unfortunately, most would prefer not to hear
    alternative, marginalised discourses because the latter tend
    to expose the very power relations that create our current
    situation and prop up those academics/scientists with a
    vested interest in the status quo.26 However, we believe that
    one of the roles of the intellectual is to decolonise, to deterritorialise
    the vast field of health sciences as it is currently
    mapped out by the EBM.
    Final remarks
    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 ‘war’ with those who have no
    regards other than for an evidence-based logic. The war
    metaphor speaks to the ‘critical and theoretical revolt’ that
    is needed to disrupt and resist the fascist order of scientific
    knowledge development.
    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 Group’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 ‘regime of
    truth’ ostracises those with ‘deviant’ 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: ‘Either you are with us, or you are with the terrorists’.
    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. 3–4)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
    – 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. (p. 8)27
    Acknowledgements
    Dave Holmes and Amélie Perron would like to thank the
    Canadian Institutes of Health Research – Institute of Gender
    and Health for funding. Stuart Murray and Geneviève Rail
    186 D Holmes et al.
    © 2006 The Authors
    Journal Compilation © Blackwell Publishing Asia Pty Ltd
    would like to thank the Social Science and Humanities
    Research Council of Canada for funding.
    References
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    Preface by Michel Foucault. Minneapolis, MN: University
    of Minnesota Press, 1980.
    2. Holmes D, Perron A, O’Byrne P. Necrospective: evidence, virulence,
    and the disappearance of nursing knowledge. Worldviews
    on Evidence-Based Nurs 2006 (in press).
    3. Foucault M. The History of Sexuality, Volume 1: An Introduction,
    trans. Robert Hurley. New York: Random House; 1978.
    4. Deleuze G, Guattari F. A Thousand Plateaus: Capitalism and
    Schizophrenia. Minneapolis, MN: Minnesota Press, 1987.
    5. Sackett D. Evidence-Based Medicine: How to Practice and Teach
    EBM. New York: Churchill Livingstone, 2000.
    6. Traynor M. The oil crisis, risk and evidence-based practice. Nurs
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  9. Ben Goldacre said,

    August 11, 2006 at 6:06 pm

    “BTW would it be a fascist idea to include your objectives under the ‘objectives’ heading?”

    hahahahahaaaaa well spotted. everything about this paper makes me laugh.

  10. Nebbish said,

    August 11, 2006 at 6:46 pm

    From the paper:

    “The mastery of scientific Newspeak is, for the most part,
    a regurgitation of prefabricated formulas (buzz words or
    catch words) that is informed by a single, powerful lexicon.”

    and yet

    “A starting point for health sciences would be to promote
    the multiplicity of what Foucault describes as subjugated
    forms of knowledge (savoirs assujettis): these forms of knowledge
    are ways of understanding the world that are ‘disqualified
    as non-conceptual knowledges, as insufficiently
    elaborated knowledges: naïve knowledges, hierarchically
    inferior knowledges, [and] knowledges that are below the
    required level of erudition or scientificity’”

    So buzzwords are bad when nasty scientists use them but great when hip trendy postmodernists use them. And as for Newspeak, their redefinition of (micro)fascism as “polymorphous intolerances that are revealed in more subtle ways.” is more chillingly Orwellian than anything I’ve heard from an Evidence-Based Medic.

    “Currently, a large number of scholars in the health
    sciences follow their colleagues in medicine down a narrow
    path leading to uniformity and intolerance.”

    If this was an undergraduate essay I’d be writing in big letters “What evidence do you have for this assertion” in the margin next to this bit. What a fascist I must be.

    You’d think with all this cleverness they’d manage to give just one concrete example of where the dreaded EBHS has led to bad outcomes but no. You need a really expensive education to become this stupid.

  11. mark said,

    August 11, 2006 at 6:53 pm

    I really can’t be bothered to read this paper, but it certainly looks from the excerpted text like a load of toss.

    Although Deleuze & Guattari are largely incomprehensible to me, I do however feel the need to leap to their defence, as someone who’s just written a PhD in the area of ‘poststructuralist’ philosophy. I’m pretty sure that Deleuze does not and would not condemn ‘evidence-based medicine’, at least not in these terms. I also suspect, though as I say I have neither read the entire article, nor to I claim to understand D&G’s though, that the authors of this article understand approximately nothing but how to spew jargon. There is a gross contrast generally between this kind of academic doppelganger, and the original thinker they ape. Deleuze for example is someone who spent his time innovated new terms and ways of looking at things, not applying others’ formulas in a lazy way to supporthis own prejudices.

    An immediate reason to be suspicious of this text is that it invokes the notion of ‘deconstruction’ in its titles, despite the fact that it does not reference the philosopher from whom that term emanates, Jacques Derrida, but rather philosophers who were by and large hostile to that specific project. They make a number of references to the main focus of my PhD thesis, Michel Foucault. The references they cite add nothing to this article but to sanctify by name-dropping (a practice Foucault never engaged in) their excuse for research. The quote about fascism they give from Foucault has nothing to do with the following sentence, which is actually a paraphrase of a passage from Deleuze & Guattari’s Thousand Plateaus.

    In short, I’m embarassed by this. But really, this is what the demand to publish is driving people to. Who now has the time to actually produce thought-out original arguments? How would such people get academic jobs? In the sciences, there are certain measures of success but in the humanities we now have research assessment mechanisms that reward circle-jerking.

  12. tom p said,

    August 11, 2006 at 8:04 pm

    Ben, Ben, Ben
    thank you so very much for finding and posting this.

    I haven’t laughed so hard in ages.

  13. tom p said,

    August 11, 2006 at 8:16 pm

    Dave Homes: www.health.uottawa.ca/profiles/dholmes.htm
    Check out his interests and, above all, his smug, smug photo
    Amélie Perron is ‘under’ Dave Holmes according to google (admittedly this is doing her PhD under him, but my phrasing makes it sound smutty)
    Check out this genevieve Rail article: www.ualberta.ca/~cjscopy/reviews/pomosport.html
    It sounds like a newspaper that’s a combination of low-grade porn and high-brow bollocks
    As for Stuart J Murray, “On the psychotheology of everyday life” anyone?

    This, unfortunately isn’t a joke. The same group of halfwits wrote a paper for the same journal called “Entertaining Fascism?” www.blackwell-synergy.com/doi/abs/10.1111/j.1479-6988.2006.00043.x – Ben, are you sure that it’s a reputable journal?

    I thought Canada had a decent education system

  14. kim said,

    August 11, 2006 at 8:42 pm

    Surely, surely, this is a spoof.

  15. oneoffmanmental said,

    August 12, 2006 at 2:50 am

    Just as an aside:

    A positive claim is a statement which tells us the way the world is
    – usually the domain of science

    A normative claim is a statement about how the world should be
    – usually the domain of politics

  16. jackpt said,

    August 12, 2006 at 4:32 am

    I looked up microfacism in the OED. It doesn’t exist.

  17. jackpt said,

    August 12, 2006 at 4:36 am

    Neither does microfacism. Presumably cryptofascist will pop up eventually.

  18. Suw said,

    August 12, 2006 at 9:28 am

    Microfacism? Does this mean, then, that eventually technology will provide us with nanofacists? Are these very, very small facists that turn to grey goo, get into your blood stream and make all your blood cells line up in rows?

  19. pv said,

    August 12, 2006 at 10:04 am

    I found a bit I understand ( and agree with, as it happens).

    “The masses never revolt of their own accord, and they never
    revolt merely because they are oppressed. Indeed, so long as they
    are not permitted to have standards of comparison they never
    even become aware that they are oppressed.”

    I know this because I live in Italy!! But I have no idea what it has to do with evidence based science. The whole piece seems more like a deranged political rant gainst something that isn’t political. The stuff of delusion and conspiracy theorists.
    It’s interesting to note that Holmes’s resumé includes mental health research. Perhaps he might think it not a bad idea to research his own – especially if he believes the pretentious twaddle that purports to be the fruit of his own mental endeavour.

  20. mark said,

    August 12, 2006 at 10:04 am

    The concept of microfascism isn’t in the OED because it’s recently been coined. The OED doesn’t invent words, but rather seeks to record their usage. Be assured that this word will be in a future edition of the OED.

    ‘Microfascism’ is a relatively servicable concept. I’m sure we all have experience of people who, while they do not necessarily hold explicit extreme right-wing political views, behave fascistically in everyday life. The application of this concept here is more dubious, however.

  21. profnick said,

    August 12, 2006 at 10:48 am

    Lexsmith comments that they have no evidence for their tosh. Surely if they provided evidence they would be succumbing to the microfascist conspiracy themselves? This is a brilliant position to adopt, talk any old bollocks and anyone who objects on the basis of contrary evidence is a fascist!
    I’m off to cash a cheque for £1M, and if my bank manager tells me I’ve only got a few hundred quid in my account, then he’s a fascist bastard, (cue Alexi Sayle)

  22. monkeychicken said,

    August 12, 2006 at 11:19 am

    I think the point the paper was trying (or should have been trying) to make was that scientists arbitrarily specify the rules for collecting evidence and that statisticians arbitrarily specify the rules for accepting or rejecting the evidence and that these processes should be deconstructed to ensure their validity and that “microfascism” arises out of refusal to re-look and re-evaluate the scientific method.

    Is the above not a reasonable thing to ask for?

    Not a medical scientists (physicist/psychologist) so maybe I am not getting it, but would it not be better to engage the academic left rather than to just take the piss (

  23. Michael Harman said,

    August 12, 2006 at 12:51 pm

    If it’s not a Sokal-type spoof, then surely it’s a SCIgen product ( pdos.csail.mit.edu/scigen/ )?

  24. j said,

    August 12, 2006 at 2:04 pm

    “I think the point the paper was trying (or should have been trying) to make was that scientists arbitrarily specify the rules for collecting evidence and that statisticians arbitrarily specify the rules for accepting or rejecting the evidence and that these processes should be deconstructed to ensure their validity and that “microfascism” arises out of refusal to re-look and re-evaluate the scientific method.”

    If the paper did this (well, a better account of ‘deconstruction’, if that’s what it wants to do/have happen, would also have been useful) it could have been an interesting paper. It doesn’t do that, though – seems more to throw in some jargon and accusations of microfascism and, well, not sure what else it does do…it makes some arguments (without providing the detail to back them up) and plays with some concepts (but not in a terribly interesting way).

    I just feel like reading that paper (quickly) is 5mins of my life I’d rather have spent doing something else. Didn’t even find it funny :(

  25. scowboy said,

    August 12, 2006 at 6:33 pm

    I think the paper has the serious weaknesses which Mark and j point out. The rhetoric is overblown, there is a lack of concrete examples and they throw in what are in effect technical terms without any thought for non-specialists (e.g. “interpellation” is used without explication). But by my reading, it’s not actually saying what most people here appear to want it to say. It’s not saying “evidence is evil” rather that “it is dangerous for a monolithic knowledge-system to become dominant, since it has a tendency to drive out a) other forms of knowledge and b) any capacity for reflecting on itself”. The knowledge-system, moreover, to which they refer is not “the scientific method” in general, but the specific practices of EBM, e.g. their point on the rules for inclusion of articles in the database (i.e. on the definition of scientificity).

    It’s not remotely my area of expertise, so I have no idea if their characterization of the dominance of EBM is a fair one. There may, I suspect, be an element of importing from other fields (e.g. criticism in political economy of “cookie cutter” policies of the IMF). But the wider point as I understand it doesn’t seem completely idiotic: that there are forms of medical knowledge which cannot be proven or disproven by random controlled trials and that these other knowledges may tend be sidelined if one system of the production and organization of knowledge becomes too dominant.

  26. scowboy said,

    August 12, 2006 at 6:54 pm

    [sorry – meant to add this comment at the end] Caricaturing people’s arguments and sneering at their photographs is not really intellectual best practice.

  27. Nebbish said,

    August 12, 2006 at 7:31 pm

    Extending the definition of fascism until it encompasses anything the user happens to be feeling grumpy about this week does a very definite and concrete favour to every skinheaded white-supremacist in the world. There are plenty of words that could have been used, and more that could have been coined, to describe the behaviours they want to discuss. But that would have deprived them of the thrill of pretending they were doing something about fascism and the chance to bully readers into siding with them for fear of siding with fascists.

    Of course it was Deleuze and Guatarri’s who started it, but these boys and girls are WAY down the postmodernist/poststructralist food-chain and therefore daren’t disagree with anything the big names say. There’s a hegemony someone ought to deconstruct. No EBH person says “Cochrane said it so it must be true” but every Po-Mo pillock is A-OK with “Lacan/Baudrillard/Foucault tell us that…” and that’s the end of the argument.

    Not that I particularly care but does anyone know what ‘Interpellate’ means?

  28. oneoffmanmental said,

    August 12, 2006 at 8:49 pm

    I think the the underlying message of the paper has some merit, and its concerns have been noted in public policy documents, the most recent one of which I’ve read was in the Millenium Ecosystem Assessment.

    I’ve seen better examples though, away from pharmaceutical testing. The most glaring example of which I’ve seen is what happened post-Chernobyl, where scientists determined that the best course of treatment to protect deer from iodine pills would be to give them iodine pills. Local farmers objected that this wouldn’t work because the deer would not eat the pills, and the best method would be take them to some hills that they reckoned would not have a wind coming from the Ukraine. The government scientists ignored with their usual assertion that their application of the “scientific method” would be far better than some local person’s lay-knowledge.
    Of course, the science turned out to be hopelessly wrong – the pills were too big for the deer, and even when they were ingested, they didn’t protect the animals from iodine. The locals turned out to be absolutely correct – soil measurements from areas where locals had suggested they move the deer were found to have little to no radioactive contamination.

    In this case, postmodern-type analysis is correct. The scientific community asserted normative claims as scientific fact (i.e. positive claims), which were later overturned by local lay knowledge – but the intermediate stage led to a loss of life that could have been avoided if lay knowledge had not been assumed to be false from the outset.

    Therefore, the scientific community has an inability to treat lay and scientifically generated knowledge on an equal footing – and then test them accordingly.

    Perhaps they mean to say that the implications for health is that some treatments that have not been developed at (significant cost) in laboratories – I would speculate that these may consist of local medicines from developing countries. However, as a counter argument, bioprospecting seems to be a rapid growth industry over the next century.

    “Strong critiques” of science can be usefu. They stir up debate in the social sciences, which leads to more nuanced empirical studies that can reveal large flaws in the application of cientific methodology.

  29. Nebbish said,

    August 12, 2006 at 9:25 pm

    Oneoffmanmental, if that was all they were saying they’d only be guilty of phenomenal overstatement, crude misrepresentation and appalling writing. It’s worse than that, here’s the smoking-gun quote:

    “But we might ask: what is the fate of that evidence that is
    invisible to us – invisible, and yet still marginally felt and
    attested to?”

    They’re not saying “evidence derived from a particular experiment/trial can in some circumstances give misleading impressions and shouldn’t be mistaken for holy gospel truth, and knowledge of evidence is no excuse for switching off your brain”, which would be correct if banal and redundant. What they’re saying is “you say evidence suggests one treatment; I say [astrology|shamanic visions|whatever] suggests another, if you itry to gnore my suggestion you’re a fascist”.

    By the way, having written and published their opening paragraph I trust each author would be willing to look and Auschwitz survivor in the eye and recite it to them?

  30. David P said,

    August 12, 2006 at 9:47 pm

    Another fine example of this kind of writing (related to physics this time) is “Postmodern Deconstruction Of Newtonian Science: A Physical-to-social Transposition Of Causality”, available here:
    theoryandscience.icaap.org/content/vol002.001/05zaman.html

    Apparently, it deconstructs Newton’s laws of motion – which seems to amount to re-writing them with some of the words replaced with other, more woo-like ones and putting others into inverted commas:

    “SAC-L1: An ‘actant’ (active, animate body) maintains its present state of rest or ‘uniform motion’ (conserves its momentum) unless directed from within to change that state by physico-social forces—which change is accomplished via an ‘agent causation’ that is perceptive and lawful.”

    Physico-social forces, anyone?

    Sadly, while they manage to continue with this approach for most of the paper, they manage to bottle it near the end by attempting to give a more concrete example:
    “‘Team momentum’ in SAC, a well known psychological phenomenon in the sports world, thus may be a real physico-social phenomenon whether in soccer, basketball, football or any other team sport. And its conservation during the game, regarded as a real phenomenon in SAC, means that one team’s gain in momentum—including that of its supporters on the sidelines—is the other team’s loss. Winning from the perspective of SAC may be primarily a matter of which side is able to generate and maintain the greater ‘physico-social momentum’ or PSM, whether in sports, politics, war, business, or whatever. The present cultural conflict in the presently ongoing ‘science wars’ (Ross, 1996) is a case in point. Whichever side ultimately wins this war of the minds in academia will do so because of the PSM that it is able to produce and sustain in the long term. Modern business is yet another example: the advertising industry from the perspective of SAC is simply a mechanism for generating and sustaining the PSM of the business world, which may often be accomplished at the expense (marginalization) of life’s other, non-materialistic aspects. The contemporary marginalization of religious faith could be one example of this. A PSM analysis can show in which cases this actually occurs.”

    The paper ends with a particularly hilarious Star-Wars themed section:
    “What we then may be observing, in the infamous ‘science wars’ of our time (Ross, 1996), is the beginning of a major conflict between two cultures in academia and society generally, one that can be explicated in the physico-social terms of SAC-mediated phenomena. One culture is the unified, global, objectivist (OEC worldview), materialistic culture of science, technology and business now dominating modern society (à la the ‘evil Galactic Empire’ of George Lucas’ ‘Star Wars’ movies); and the other is a rebellious, pluralistic, subjectivist (SAC worldview), more spiritually oriented culture (à la Princess Leia, Luke Skywalker, Obi Wan Kinobi, Yoda, Han Solo and others of the ‘rebel alliance’) surviving from earlier, less materialistic times. The ‘death star’ of the evil empire in this Star Wars analogy, symbolizing a spiritual force turned to the ‘dark side,’ could be the dominant ‘scientism’ of modernity—a force that is now enveloping the world, and which seemingly is intent on destroying all opposition (Appleyard, 1992). Indeed, might not this analogy identify a psychological subtext—whether conscious or unconscious—of Lucas’ metaphorical vision?”

  31. scowboy said,

    August 12, 2006 at 11:28 pm

    It seems to me that “But we might ask: what is the fate of that evidence that is
    invisible to us – invisible, and yet still marginally felt and
    attested to?” does pretty accurately describe the case mentioned by oneoffmanmental. The evidence of the farmers was, to all intents and purposes, “invisible” to the Soviet authorities because of their presumptions about what was admissible and what not. Its fate was to be ignored. Moreover, these presumptions are best explained not by reference to any contents of the scientific question at issue, but rather by the kind of historical and social factors (Here: Stalinism, bureaucracy, etc.) that the authors are trying to point to, however crudely and in a rather hectoring, provocative tone. Maybe I’m being too generous to the authors of the paper: the big hole in their position is that they don’t indicate how to tell the difference between useful extra-systemic knowledge and, say, astrology, but surely in any specific case, this would be more clear.

    Nebbish: I agree with you on the misuse of ‘fascism’, in general and in this specific instance, but an Auschwitz survivor is not actually better qualified than anyone else to judge the proper use of the term.

  32. oneoffmanmental said,

    August 12, 2006 at 11:33 pm

    Oh, this was UK authorities in Cumbria, not Soviet btw.

  33. DrHyde said,

    August 13, 2006 at 12:00 am

    Huzzah, my hypothesis that whenever someone mentions Derrida, someone is talking utter bollocks, passes yet another test!

  34. scowboy said,

    August 13, 2006 at 12:09 am

    Your own post apparently being a case in point, Dr. Hyde…

  35. profnick said,

    August 13, 2006 at 11:40 am

    “Caricaturing people’s arguments and sneering at their photographs is not really intellectual best practice.” scowboy
    Anything in particular in mind?
    Rule 1 of the Rules of Engagement: “Try to be combative, intelligent, and rude,” Two out of three is a start.

  36. BSM said,

    August 13, 2006 at 12:46 pm

    “What does ‘dangerously normative’ mean with regard to scientific knowledge? That it does tend towards a normal distribution and that’s a bad thing? What distribution should it have instead?”

    Sorry, Coracle, you’ve got your concepts muddled.

    Normative does not relate to statistical distributions.

    dict.die.net/normative/

    normative
    adj 1: relating to or dealing with norms; “normative discipline”;
    “normative samples”
    2: (grammar) giving directives or rules; “prescriptive grammar
    is concerned with norms of or rules for correct usage”
    [syn: prescriptive] [ant: descriptive]
    3: based on or prescribing a norm or standard; “normative
    grammar” [syn: prescriptive]
    4: dealing with or based on norms; “a normative judgment”

    In this context, what it means is that EBM and, by implication, the scientific process has been allowed to define what is normal and permissible in discourse about medicine.

    AND DAMN RIGHT TOO!!!

    What these yo-yos fail to produce is any kind of meaningful alternative. Probably because there is none, but they are too woolly thinking to realise this beyond a vague notion that, one might surmise, their favoured forms of superstition-based medicine are under attack from nasty reality as revealed by science.

    Esseentially this is yet more of the usual crap produced by supporters of quack medicine as a form of special pleading to allow them to persist in their nonsense.

  37. Nebbish said,

    August 13, 2006 at 12:48 pm

    On the other points it looks like we’re playing the tired old “strong form/weak form” one-two that pervades most of the subjects of “Intellectual Impostures”. The way this works is that you put forward a radical implausible statement such as “Poetry can be analysed mathematically” or “The gulf war never happened” or “There is no external reality” or “Basing treatment decisions on evidence is fascistic”. After you’ve made the headlines and sold copies of your book and are asked how you can possibly believe what you’ve said you trot out the weak form: “Mathematics is a metaphor for poetry”, “The gulf war has aspects in common with virtual reality”, “We can’t be sure what external reality is”, “Its possible to make mistakes even if you have all the evidence”. Strong form = controversial but absurd, weak form = reasonable but boring.

    It’s a form of intellectual dishonesty, if you really believe the weak form argument you should have the courage to say so and the diligence and dedication to get the message across. Going straight for the strong form actually weakens sympathy for the case for the weak form. But that presupposes that such an author actual cares about the message he gets across, as opposed to the fact that he/she’s got it across.

    Scowboy: I’m not saying that an Auschwitz survivor is more qualified to judge, I’m asking whether Holmes et al would have the stomach to do what I suggested. In other words I’m questioning the sincerity of their statements. If they really truly believed it they’d be willing to do so. I suspect, however, that they just like to sound controversial and I think this would be a good test to see who’s right.

  38. coracle said,

    August 13, 2006 at 3:55 pm

    Yeah, BSM, it was supposed to be slightly tongue in cheek! Whenever I see a word close to ‘normal’ , in an article on science I automatically think of normal distribution.

  39. oneoffmanmental said,

    August 14, 2006 at 10:26 am

    Most authors of strong critiques don’t then put out a corresponding weak critique of science.

    Having attended a lecture series of Slavoj Zizek’s, I’m pretty sure he really means everything he says.

    To say fascism died with Hitler, or that fascism is defined by Nazism is a bit naive at best..

  40. BorisTheChemist said,

    August 14, 2006 at 11:09 am

    I can’t write anything decent, my jaw is in the way of the keyboard.

    How totally dumb.

  41. Dr Aust said,

    August 14, 2006 at 1:53 pm

    As several people have pointed out, there MIGHT (just barely) be a sensible point in there… namely that rule-based analyses depend on how “good” the rules are, e.g. the criteria for inclusion/exclusion in EBM. So the rules need occasional re-examination and tweaking

    However, to dress this up in 1000s of words of impenetrable sociological jargon and tag the use of evidence-based paradigms with the (apparently) fashionable new socio-left label of “microfascism” just exemplifies why scientists (who deal in the practical) think cultural studies and “philosophy of science” types are such Howard Kirk-esque time-wasting pseuds.

    “An evidence-based, empirical world view is dangerously reductive insofar as it negates the personal and interpersonal significance and meaning of a
    world that is first and foremost a relational world, and not a fixed set of objects, partes extra partes. ”

    Probable transl: Empiricism struggles to explain every single thing that you personally perceive and what you take it to mean.

    Well, Duh. This in no way negates empiricism as a way of doing science, or indeed empiricism in general.

    “Of course, we do not wish to deny the material and objective existence of the world…”

    Phew – I was getting worried there.

    “…but would suggest, rather, that our relation to the world and to others is always mediated, never direct or wholly transparent. Indeed, the sociocultural
    forms of this mediation would play a large part in the way the world appears as full of significance. ”

    This is just the same old tired post-modernist/ structuralist view that every piece of knowledge/information is 100% relative or “coded” by your personal prejudices / B/G / upbringing etc. So there is no objective true or false. A great parlour game for bamboozling people at Faculty parties but ultimately the most tedious navel-gazing. No wonder the intellectual left has been so stranded these last 30 years.

    Anyone who has done any science can see this as (empirically) total bollocks. While one must never forget that scientists are humans with human prejudices (re-read Stephen Jay Gould’s “The mismeasure of man” if you need reminding), what is the point of a POV that tells you that in effect all views of anything are equally valid? This is like (to take a regular Bad Science subject) saying homeopathy is as valid as EBM because scientific rules are “micrfascistic” and exclude homeopathic evidence (people telling you they believe it). Sound familiar?

    I know which “view” of how the body works I would prefer my doctor to have.

    The thing I find most amazing is that these people work in a Health Sciences Faculty (or was in Nursing?). I’ve met some medical sociologists in my time, but this takes the biscuit. Are we really REALLY sure this is for real?

  42. warumich said,

    August 14, 2006 at 3:06 pm

    I dond’ think you’re being completely fair here, DrAust. Why is it wrong for sociologists to use sociological jargon? You don’t expect to read a chemistry paper and have every piece of chemistry jargon explained to non-chemists, so why should there be different rules for sociologists? You could argue that it’s the wrong journal for this discipline, but then editor obviously didn’t think so.

    As it happens, I find the piece impenetrable myself, and I come from a science studies background. And it pains me to have to defend it, because they give my discipline a bad name. But nevertheless, just because you don’t understand something doesn’t mean it’s nonsense.

  43. BorisTheChemist said,

    August 14, 2006 at 4:29 pm

    warumich, the difference is that chemical jargon is, for the most part, codified so that it can be understood by others who are educated in it easily. I have been reliably informed by a friend of mine who is researching in social science that no such codification exists in social sciences. Debates rage between individuals based on their different definitions of terms in that area. She confessed to me at at lunch that she often has to go back and check an author’s history to try and guess at their definition of some terms that she hasn’t come across. On the other hand in my field reviewers get very itchy about anything that is not well defined or common knowledge in the area – I recently had to write a lengthy description of a technique already defined by 3 seperate papers in major journals in the area just to get published (because it is not widely used)!

  44. tom p said,

    August 14, 2006 at 5:09 pm

    Dr Aust – Howard Kirk? As in the history man? That’s just what I was thinking of when I read this, but I couldn’t remember the play or the character’s name.

    Warumich – The article was in the Int. J. Evidence-Based Healthcare. I rather feel that it ought to be incumbent on the authors to explain the sociological jargon to an audience that would likely be comprised of mainly non-sociologists

  45. Nebbish said,

    August 14, 2006 at 6:03 pm

    “To say fascism died with Hitler, or that fascism is defined by Nazism is a bit naive at best..”

    Oneoffmanmental, I’d go further and say it’s quite incorrect. Has anyone made this claim?

  46. j said,

    August 14, 2006 at 6:52 pm

    Are one or two of the other articles in the journal critiques of ‘deconstructing the evidence-based discourse…’? If so, would be interesting to know to what extent they take it apart – the journal won’t even show any abstracts free of charge…fascists…

    I’m not convinced sociologists would understand what the jargon in the paper ‘means'; I’ve read around bits of this area of work, and it’s certainly not clear to me (though this could just be me, of course). The authors never explain what they mean by key terms like microfascism and deconstruction and, although Derrida and Deleuze and Guattari were never exactly explicit when they introduced the terms, the authors of this paper seem to use them in a different way from these authors meant.

  47. wotsisnameinlondon said,

    August 14, 2006 at 7:01 pm

    I tried. Honestly I tried several times to read this thread. Each time I ended up with a headache.

    I’m off to the Philosopher’s to get an aspirin.

  48. warumich said,

    August 14, 2006 at 7:19 pm

    Sure, you’re right, Boris, and bloody annoying it is too if you want to do some social research. Don’t get me wrong, I think the article above is absolute tripe… though I don’t know anything about Derrida or Deleuze or Guattari, so I wouldn’t be able to judge if they misused the terminology. Sociology is unfortunately too split into little subgroups for any sociologist to be able to properly judge stuff from a different subgroup. Irritates me no end, but there’s nothing anyone can do about it right now.
    Anyway, I do my very best to define my terms, and when it’s not possible to provide proper references, and when I see stuff like that I sometimes wonder why I bother.

    It’s just the generality of Dr Aust’s statement that made me see red. Sociology needs its jargon just like any other discipline, otherwise we’ll never be able to keep to the word limit, so please don’t begrudge us that. But of course that’s not an excuse for sloppy writing.

    As for what posessed the editors of the journal to publish it, I can only guess, but I think it’s unfair to blame the authors for adhering to no more than what was demanded of them.

  49. bentrem said,

    August 14, 2006 at 7:28 pm

    Apologies if you’ve already had this cited; I’ve got about a dozen tabs open … ButterfliesAndWheels.com in one set, The Philosphers’ Magazine Online in another … an embarassment of riches!

    I think this is sychronous: I just came across Pharyngula’s “Would you let Foucault or Derrida treat your cancer?” (“Martin Rundkvist has discovered a peculiar little paper.”)

    cheers

  50. Ben Goldacre said,

    August 14, 2006 at 8:02 pm

    mm those blog entries are all well after mine, it would actually be great if any of these other people who [coughs] dont link back here had scoped the journal themselves, because that would mean they had access to it, and then we could all finally have a look at the responses to the article in the same issue. unforrtunately they all seem to be referring to the same PDF i got emailed from my anonymous benefactor, which david is kindly hosting.

    it’s actually quite interesting to see how story ownership changes with different media. the evening standard and independent, you’ll remember, when they picked up on the brainiac story, both chose to reference badscience.net as finding the story, because they didn’t want to be seen lifting a story from the guardian, another newspaper, they wanted it to look like they’d magicked up the story themselves; meanwhile bloggers’ references to the brainiac story all referenced either badscience.net or the guardian column.

    with this critical theory story, which i dropped on badscience.net first because the PDF got emailed to me just an hour too late for the friday deadline at the guardian (and i’ve got more on it for next week anyway), the first people to pick it up (like the totally excellent butterflies and wheels site) naturally ref’ed back here, and then gradually it got lost, although they all still linked to david’s pdf (which i hope he’s ok with).

    what’s interesting to me is, it’s pretty certain that if i’d kept quiet and then put it in the guardian next week, then in the minds of bloggers it would have been “my” “scoop” more. i’m not huffy about that, i just think it’s interesting how a blog entry and an article in “old media” newspaper form might get treated differently, even by bloggers.

  51. superburger said,

    August 15, 2006 at 1:25 am


    Dave Holmes RN PhD,1 Stuart J Murray PhD,2 Amélie Perron RN
    PhD(cand)1 and Geneviève Rail PhD1″

    are the authors. I assume that RN is registered nurse as it is in the USA. How can two qualified nurses, who must have some clinical experience write such drivel?

  52. Dr Aust said,

    August 15, 2006 at 1:55 pm

    Few quickies:

    1. Warumich – I take your point about each discipline having to have it’s own jargon, and I was in overdrive rant / polemic mod, so you must forgive me a bit of my spleen…

    BUT… my impression HAS been that many sociologists, cultural theorists and similar take great delight in inventing their own new jargon with every paper, the more obscure the better. And the point often appears to be to mystify the reader and guru-ize (can I say that?) the writer. So it is qualitatively different to science and medicine, where the terms have precise meanings, as already pointed out about above by Boris.

    This is a shame, because it alienates any reader from outside the tiny clique of followers and obscures any really useful thoughts therein. A recurring problem of many social scientists. When I was a kid my next door neighbour was a famous sociologist, Basil Bernstein, whose main ideas on language, class and education (“elaborated and restricted codes”) were important, clear and sensible, and who was one of the most lucid and witty talkers I have ever known. But he spent most of his later professional life repackaging and disguising all his thought in the most dementedly obscure neo-structuralist socio-babble.

    And if scientists do the same with their jargon, they are just as guilty…!

    I think you said it all yourself on the article in question:

    “As it happens, I find the piece impenetrable myself, and I come from a science studies background.”

    ‘Nuff said.

    2. Tom P – Howard Kirk IS indeed The History Man, in the novel of the same name by the late and much-missed Malcolm Bradbury. The BBC made it into quite a funny TV drama, recently repeated on BBC 3 or 4.

    3. Superburger – RN is indeed a registered nurse – the lead author, Dave Holmes, is a registered psychiatric nurse as well as an academic, and is interested (according to his webpage – someone gave the URL near the start of this thread) in “power relationships” in therapeutic settings. This sort of chimes with the paper, which purports to be about “power relationships” in the way truth or “evidence” is sought / defined in medical research. It’s still a load of impenetrable bollocks though. I stick to my previous take that this articles represents a kind of cultural smart-arse-ist “blind -‘em-with-jargon” tendency. A bit like a conjuring trick. The journal editors should be ashamed of themselves for publishing it, at least in its present form.

  53. superburger said,

    August 15, 2006 at 9:45 pm

    Sweet Lord, have you been to davie holmes’ website. He’s a either a webdesign pro, or has paid good money for it to be done?

    Sort of Brian-Enoish ambient music in the background, with no discernable ‘off’ button.

    Though I know know that most of his work follows a “poststructuralist approach”

    His lengthy CV lists all of his invitations to speak at conferences. Including “Sex and Desire in Gay Bath Houses: An ethnography”

  54. sockatume said,

    August 16, 2006 at 8:28 am

    BorisTheChemist: In “Surely You’re Joking, Mister Feynman!” there’s a story about Feynman crossing paths with a group of humanities types. And yes, with a little prodding from him, it became clear that they all had completely different ideas about what the jargon meant, so that when somebody gave a lecture, everybody left with a completely different version of events.

  55. warumich said,

    August 16, 2006 at 9:04 am

    Dr Aust: Apology cheerfully accepted. I was in a bit of a ranting mood myself, as if you couldn’t tell.
    Social science waffle can get a bit overblown, especially on the cultural studies end. I really don’t know if it’s all genuine. Since it’s not my area, I always strive to give people the benefit of the doubt though, and assume that what they’re talking about makes sense, at least to them.

    Do they invent jargon and sound pompous on purpose? My first instinct is to say, no, they probably believe that what they are doing is proper academic research, and that they are just following the academic culture as they know it. After all, as far as I know, a lot of cultural studies people complain about the impersonal style of natural science papers – for example, there’s absolutely no precision lost if you write physics papers in the active rather than the passive voice. And if you have a look at the Royal Society papers from the 19th century, you will find that the style was completely different, even though the science itself was proper. What I’m trying to say in a very laboured way is that academic style is very much dictated by fashion, and it’s really, really hard to break out of it (just imagine what would happen if you submitted a chemistry paper written in the first person). So if cultural studies people don’t write in this horrible way, they will find that cultural studies journals don’t publish their work.

    But even so, I’m stumped that they seemingly believe that writing style is going to win them any friends outside the discipline. I’m off to a Science Studies conference next week, where I’ll have the chance to ask some of them directly, do a bit of an ethnographic study, if you like… sorry for the long post…

  56. Dr Aust said,

    August 16, 2006 at 10:42 am

    Hi Warumich

    I agree that the cultural studies crew are no doubt “following the academic culture as they know it”. But in effect that is telling you that the academic culture in their area is intellectually pretty much bankrupt, as Sokal so hilariously demonstrated with his Social Text hoax.

    You are right about the precise WRITTEN style of scientific papers being determined by convention, of course. But at least the convention is COMMON, in the sense of “used by everyone”. One of the things I feel gives science as a collective undertaking its strength, getting a bit earnest here for a minute, is precisely its collective nature – it is the undertaking of many many hands and minds, from many cultures and countries (even if some are dominant), examining, testing and re-testing. This collective nature in turn relies upon a common technical language, understood by everyone who participates in the collective undertaking. To my mind this is the real gulf (chasm?) between experimental sciences and (much of) social sciences – common language of discourse (as a social scientist might put it!) vs. invent-your-own jargon.

  57. superburger said,

    August 16, 2006 at 2:10 pm

    the elephant in the corner that we are seemingly ignororing is that the stuff they wrote was pretentious drivel. The whole paragraph drawing comparisons between Orwell’s ‘Newspeak’ in 1984 and evidince based health is pure and total bollocks.

    “Those who are wedded
    to the idea of ‘evidence’ in the health sciences maintain
    what is essentially a Newtonian, mechanistic world view:
    they tend to believe that reality is objective, which is to say
    that it exists, ‘out there’, absolutely independent of the
    human observer, and of the observer’s intentions and observations.
    They fondly point to ‘facts’, while they are forced
    to dismiss ‘values’ as somehow unscientific. For them, this
    reality (an ensemble of facts) corresponds to an objectively
    Deconstructing the evidence-based discourse”

    Is total drivel.

    Almost every papragaph contians something that is patently absurd.

    If their premise is the EBM is not a good way of conducting medicine, then they have offered no proof other than some fancy wordplay quoting whatever philosophers suit their mood.

    What is the journal they wrote in like? Is it a genunie healthcare journal or is it a social sciences journal? Is it respected, anyone know the impact factor?

    Does anyone think the collective badscience hivemind could write a rejection of this paper, and have it published?

  58. ceec said,

    August 16, 2006 at 11:31 pm

    I don’t know if any of you have ever noticed this, but there is some really appalling tripe published in every field. It’s just not particularly funny when it’s e.g. statistics. Tempting as it is to blame “sociology” (and nb, evidence-kids, these people trained as nurses so may not be the best example of “sociologists”), you could equally blame being a bit a bit crap at thinking – a problem even trained scientists occasionally suffer from (see my post above about ladies needing compliments about their hats).

  59. ceec said,

    August 16, 2006 at 11:45 pm

    p.s. I’ve never heard of International Journal of Evidence-Based Healthcare – has anyone else? Are we dealing with the evidence-based medicine equivalent of the North and Mid-Devon Journal of Nuclear Physics?

  60. jj_hankinson said,

    August 17, 2006 at 12:05 pm

    For those that haven’t read it, Richard Dawkins wrote an excellent essay called ‘Postmodernism Disrobed’ on this very topic.

    www.physics.nyu.edu/faculty/sokal/dawkins.html

    I would definitely recommend Dawkins’ Devils Chaplain book which contains more of his essays.

  61. oneoffmanmental said,

    August 17, 2006 at 12:11 pm

    Just referring to a book on the Public Understanding of Science, written by a physicist, no less:

    “Both ‘Science in Action’ and ‘The Golem’ critique the public image of science from the standpoint that real science owes a lot (if not all) of its character to the social practice of scientists; by and large, they concentrate on internal (or micro) social pressure (although external resourcing is clearly a factor). Both books are broadly in the tradition of what has come to be known as the “strong program” of the sociology of scientific knowledge. One of the key centres of critiques of science from within the strong program has been the University of Edinburgh, from where David Bloor published ‘Knowledge and Social Imagery’ in 1976. Bloor’s book attempts to analyze the (macro) social influences essentially external to science that shape its development. He raises questions as to whether sciences as scientists invariably absorb the spirit, common sense and culture of their times – and, if so, how much this affects their work and its framing. Examples might include the preference of English geologists for gradual uniformitarianism in the early 19th century as against the abrupt catastrophism of their revolutionary neighbours across the Channel and the role that the scepticism and disillusionment of the 1920s may have played in giving rise to the “uncertainty” and probabilistic nature of quantum mechanics.
    Traditional histories of science have depicted the evolution of scientific ideas as a gradual, or sometimes cataclysmic, replacement of incorrect theories by ones that are closer to the truth. Thus, Stahl’s phlogiston theory of burning was replaced by Lavoisier’s understanding that combustion involves combination with a component of air called oxygen. This idea of “oxidation” is now interpreted more generally by chemists in terms of the transfer of electrons between atoms. Error has been replaced by truth, and truth by more general truth. Bloor, however, considers this an insufficient explanation for the history of science and demands “symmetry”:

    “The strong programme of science enjoins sociologists to disregard [truth] in the sense of treating both true and false explanations alike for the purposes of explanation”

    For the purposes of sociological research, then, this puts beliefs in witchcraft and how magic powers are inherited on the same footing as a scientific understanding of genetics or mathematics. Social processes are at work in the formation of all beliefs, and it is the job of the sociology of knowledge to examine the sociological aspects of these processes, not to judge whether or not the particular beliefs are “true.” The symmetry principle allows sociologists, for the purposes of their inquiry, to suspend disbelief and to treat all forms of knowledge as valid within the circumstances in which they arose. This is not to say that the sociologists themselves believe that all forms of knowledge are equally valid: the symmetry principle is a methodological tool, not a judgment on the relative value of ideas.
    Academically at least, sociologists leave value judgments to others.
    For Bloor, while the material world produces “casual promptings” that appear in experimental results, and thus in scientific ideas, theories are, at heart, “social conventions” accepted by scientists:

    “The question may be pressed: does the acceptance of a theory by a social group make it true? The only answer that can be given is that it does not. There is nothing in the concept of truth that allows for belief making an idea true. Its relation to the basic materialist picture of an independent world precludes this. But if the question is rephrased and becomes: does the acceptance of a theory make it the knowledge of a group, or does it make the basis for their understanding and their adaptation of the world? The answer can only be positive.

    Thus, there may be a gap between truth and these social conventions, although Bloor is keen to emphasize that recognizing that there are social influences shaping scientific knowledge does not necessarily make that knowledge wrong or invalid. The “role of ideas” and “social factors” are not in competition.
    Bloor accuses those who would deny social science the right to investigate knowledge, and how it is formed, of mystification. And he goes further, saying that there is a tendency to mystify knowledge when the guardians of that knowledge feel under a social threat.”

    – Gregory, J. and Miller, S. (1998) Science in Public. New York: Plenum Press

  62. Dr Aust said,

    August 17, 2006 at 1:12 pm

    But of course this idea of “symmetry” – assuming nothing about some ideas being broadly right, and some wrong – strikes scientists as utterly idiotic precisely because some ideas are EMPIRICALLY (by experiment) better than others.

    The theory of air pressures, lift, and so on is a good set of laws because it explains why an aeroplane made of hundreds of tonnes of steel and auminium can fly. The alternative theory, that you can levitate through Yogic chanting, has never yet lifted a 747 off the ground, or even a balsa-wood model.

    If you ask a scientist what is the central progressive process of science, they might say “ideas about how things work replaced by better ideas on how things work on the basis of experimental test”. To insist on regarding this as simply one socially constructed set of ideas among many may work for a sociologist as a theoretical critique, but in PRACTICAL terms is utterly useless. Angels fitting on a pinhead come to mind.

  63. ceec said,

    August 17, 2006 at 2:29 pm

    You seem to be caricaturing sociology based on little or no evidence (surely in contravention of the spirit of this website). Yogic charming? I mean really.

    One completely legitimate area of enquiry is to investigate who decides what experiments are done in the first place, and why, and in whose interests it is to investigate particular things. There is no god-given set of experiments that people are just slogging through in order: what people think is important at any particular time is er… I hate to say it… socially constructed.

    Angels and pinheads may be crossing your mind, but I think a big straw man may have put them there.

  64. ceec said,

    August 17, 2006 at 4:04 pm

    p.s. I can’t find Int J Ev Based Health Care listed on PubMed, or on Web of Knowledge, which suggests to me that it must be extremely crap. Anyone have evidence to the contrary?

  65. Ben Goldacre said,

    August 17, 2006 at 4:06 pm

    “I can’t find Int J Ev Based Health Care listed on PubMed, or on Web of Knowledge, which suggests to me that it must be extremely crap.”

    Fascist.

  66. ceec said,

    August 17, 2006 at 4:24 pm

    oops – chanting, not charming

  67. Dr Aust said,

    August 17, 2006 at 6:22 pm

    Well, I admit to not applying evidence-based rules here – guilty, m’lud. However, virtually all my personal experience of science studies and science philosophy-types has been that they largely exist to either:

    (i) state the obvious in ludicrously coded language to make it sounds profound

    (ii) talk a load of meaningless waffle, especially when they try to insist that what they do is something that the actual scientists should know/think a lot about.

    So my evidence is anecdotal, but based on a quarter of a century of working in science… during which time the number of science studies people has increased enormously, as have their claims about their own importance as “interpreters” of the scientific process or “the nature of scientific evidence”.

    Personally I don’t think their work has offered any useful insight into how actual SCIENCE should be done. It has, however, given plenty of ammunition to legions of bad science types who use these arid pseudo-sociological wankings about “the hegemony of evidence-based paradigms” to discredit scientific consensus and therefore claim spurious standing for their own nonsense, whether HIV-in-AIDS-denying, anti-animal experimentation, anti-vax, thimerosal-scare touting, bogus herbal cure-promoting or whatever.

    In the spirit of enquiry, though, I would be delighted to be referred to any lucid and READABLE (note) science studies text that would prove me wrong.

    PS Science EDUCATION, incidentally, parallels this scenatio in many ways. It is typical to have whole departments full of “specialists in science education”, going on and on about how children should be taught science, none of whom has ever DONE any science beyond a first degree. The flight from science subjects at A level in the UK tells you all you need to know about the success of this approach.

  68. j said,

    August 17, 2006 at 9:44 pm

    To be fair, there’s been a lot of work in science studies that is at least much better than this. For example, a lot of the work done under the umbrella of ‘actor-network theory’ has gone into lots of interesting empirical detail as to what scientists do – and is thus interesting even if you disagree with a lot of its theoretical and philosophical positions. Some of Bruno Latour’s work, for example, or Annemarie Mol… Latour in particular is pretty readable (his latest book on ‘actor-network theory’ reads almost like an undergrad textbook).

  69. Ben Goldacre said,

    August 17, 2006 at 11:34 pm

    “I don’t know if any of you have ever noticed this, but there is some really appalling tripe published in every field. It’s just not particularly funny when it’s e.g. statistics.”

    But it’s the combination of such simple foolishness with the spectacular grandiosity of the project that gives this paper its true comedy value. The inappropriate deployment of a one tailed t-test in a small study doesn’t compare on my own – entirely arbistrary – comedy paper rating scale.

  70. warumich said,

    August 18, 2006 at 12:06 pm

    Dr Aust:

    ‘In the spirit of enquiry, though, I would be delighted to be referred to any lucid and READABLE (note) science studies text that would prove me wrong.’

    I think the book by Miller and Gregory that was mentioned above is a good starter as an introductory textbook – it was my own introduction to science studies after I came to the field with no prior knowledge apart from a physics degree and lots of skepticism.

    Currently my favourite science studies book is ‘Defenders of the Truth’ by Ullica Segerstrale (2000), which is for some reason marketed as popular science by Oxford Uni press, but is in fact a proper sociological study about the sociobiology controversy. You know, E.O. Wilson, Lewontin, Gould, Dawkins and all that. Provided that you agree with her argument of course, I think this is a prime example of where an understanding of the social background of science is really important. Even the notoriously hard-to-please Matt Ridley gave it a good review.

    On the other hand I find Latour completely indigestible, I’m afraid to say, j. Though I suspect that I don’t really understand what he’s trying to say.

  71. warumich said,

    August 18, 2006 at 12:46 pm

    Oh, and I’m slightly baffled over your comments on Science Education, as in my experience these departments are chock-full of ex-scientists.
    But I’m also a bit concerned about what you’re saying regarding its usefulness, and that of science studie generally. Sure, it seems that they are having little effect at the moment in reversing the decline of A-level uptake in science or the increase in all that creationism lunacy. But the fact that they aven’t found a cure for it doesn’t mean that their research is useless. After all the fact that there is no miracle cure for cancer doesn’t mean we can all start lampooning all those hapless oncologists.
    Look at the alternative option we have right now: Every time a scary opinion survey is published, the Royal Society panics and invites Steve Jones to give a lecture, rename 2005 the ‘Einstein year’ and maybe pay for a couple of monkey exhibits in the Science Museum, without there being any evidence that these kind of knee-jerk reactions have effect whatsoever. Instead, lots of effort and time is wasted on ridiculing those who really do try to gather evidence on how children learn and evaluate science (i.e. science education) or even how scientists themselves learn and evaluate science (i.e. science studies). Ok, we’re not perfect, and our discipline is not the most important of them all, but it’s not irrelevant.

  72. warumich said,

    August 18, 2006 at 1:32 pm

    sheeesh, didn’t mean to sound quite so angry, sorry….

  73. superburger said,

    August 18, 2006 at 2:45 pm

    “The inappropriate deployment of a one tailed t-test in a small study doesn’t compare on my own – entirely arbistrary – comedy paper rating scale.”

    I’m racking my brains to think of any ‘proper’ science I have come across that is as patently abusrd as the above drivel.

    I still wonder what happend to the authors to turn them over to the dark-side of PoMo.I mean when he was training as a nurse, did he see the microfacism of EBM at work and think about how he could challange it? Or is it the realisation that one can, in principle, earn a decent wage (and have a very snazzy website) out of writing fashionable nonsence. That process would be worthy of sociological study……….

    PS the fact that Cochrane fought for the IB is just about the best thing I have heard this week…..

  74. Ben Goldacre said,

    August 18, 2006 at 2:50 pm

    archie cochrane didnt just fight for the international brigade, he dropped out of medical school to go and fight for them. what a hero. and then he was a prisoner of the nazis for 4 years.

    cochrane fought real fascism and totalitarian violence, and he was cool with it: in his autobiography he explains that he was only caught by the germans in the mediterranean because he “couldn’t swim to egypt”. what a geezer!

  75. ceec said,

    August 18, 2006 at 3:08 pm

    “I’m racking my brains to think of any ‘proper’ science I have come across that is as patently abusrd as the above drivel

    No need to rack too hard – just open an equally minor-league journal in any discipline and you’ll reap rich rewards, I’m sure. It’s patently absurd, but just not as funny – except for those hilarious equations I found the other day…

  76. ceec said,

    August 18, 2006 at 3:09 pm

    … though I suppose even the most hilarious equations don’t usually end up accusing you of being a facist.

  77. warumich said,

    August 18, 2006 at 3:16 pm

    Don’t know if any of you are familiar with this story

    en.wikipedia.org/wiki/Bogdanov_Affair

    But it’s really, really funny

  78. superburger said,

    August 18, 2006 at 3:20 pm

    “No need to rack too hard – just open an equally minor-league journal in any discipline and you’ll reap rich rewards, I’m sure.”

    Oh, I’ve seen plenty of stuff that’s made me wonder how it got published. Mainly the method is so flawed that any results are meaningless.

    But at least it appears to be an honest attempt at ‘real’ work, rather than fancy wordplay….

    “archie cochrane didnt just fight for the international brigade, he dropped out of medical school to go and fight for them. what a hero. and then he was a prisoner of the nazis for 4 years.”

    The girlfriend’s grandad fought for the IB (and is still alive and kicking at 93) he was at a reunion recently in London and a journo from a tabloid interviewed him, she didn’t have a fucking clue about the civil war or the IB – it made me pretty angry to think she couldn’t even be arsed to google for some background before going to interview a group of heros, of which very few are still around.

  79. StephenAWells said,

    August 19, 2006 at 4:01 am

    Posted this to the other Cochrane thread too, but I meant it for here.

    Presumably, when the authors of this paper go to a grocery store, and they pick up an item priced at £2 and an item priced at £3, and the clerk rings up a total of £7, they understand that the idea that 2+3 = 5 is dangerously normative, while the clerk’s belief that 2+3 = 7 is a deviant form of knowledge, and suppressing it would be an act of arithmetic microfascism. So they happily pay the £7.

    No?

    Didn’t think so.

  80. Michael Harman said,

    August 22, 2006 at 12:43 pm

    Post 51, Superburger asked about qualified nurses writing such drivel. But some forms of nursing theory are drivel. See, for example, TT (Therapeutic Touch). There’s a critical account of it here:

    jef.raskincenter.org/main/published/NursingTheoryForSite.html

  81. DrGlenn said,

    October 19, 2006 at 3:18 pm

    The point of post-modern theory is to highlight the politics in our knowledge construction. Even today ‘hard’ scientists don’t get the idea that when science and society come together science becomes a political issue that is often defined by those who hold power in society. Hard scientists also don’t seem to get the idea that they themselves bring a politics to all that they do. It amazes me that there are still scientists out there who have not got one clue about how their personal and social politics influences the direction of their ‘objective’ science, instead rubbishing any attempt at illustrating this. It also amazes me that such people also fail to see that sometimes this lack of insight into the politics of science has been a source of great pain to many people especially within health care. Health care has many examples of scientific enquiry that failed to acknowledge the social context in its attempts to maintain a sense of scienftic truth that only ever existed in the minds of naive and socially unaware scientists. In this sense questioning perceived ‘truths’, power relationships and calling the continued dominance of ‘hard’ science without social insight as fascism is not far off the mark. May I also add that for far too long there has been a real scandal in allowing some scientific methodology based on the objective goals of ‘hard’ science to explore some social issues and in the process creating simplistic and prejudicial generalisations.

  82. DrGlenn said,

    October 20, 2006 at 6:03 pm

    …and might I add that the idea of a meta-analysis being superior to one individual trial really empahsises to me the lack of knowledge ‘hard’ scientists have of research politics. The classification of evidence as given by the cochrane group has been based on a hierarchy of knowledge and which until recently rated personal experience at the bottom of the list of knowledge production – all that qualitative stuff they really did not know what to do with basically because they didn’t understand the politics of research or that some scientific methods are simply innapropriate for exploring social issues. This does not surprise me because most ‘hard’ scientists fail to understand not only the politics of science but also how some things can only be fully understood using personal experience and if properly handled such data can avoid all those prejudicial generalisations that good old “we can rerpoduce that again, lots of studies replicate the same conclusion, we can give a nice little percentage to that social issue etc etc” ‘hard’ science.

  83. Psychobabbler said,

    October 29, 2006 at 12:41 pm

    Whether it is Post Modernist or not, there is evidence to suggest that being reflective on your methodology may produce radically different results/conclusions. The current example I find interesting is the Auton case in Canada.

    www.sentex.net/~nexus23/naa_vic.html

    Here the ‘hard science’ end of psychology (behaviourists and physiologists) made normative judgements about autistics that clearly defined them as ‘abnormal’. Flowing from this ‘judgement’ treatment programmes were put forward to ‘fix’ autistics.

    However the autistics themselves had very little input into treatment programs for autistics. >>>>>>(Dr Glenn wrote The classification of evidence as given by the Cochrane group has been based on a hierarchy of knowledge and which until recently rated personal experience at the bottom of the list of knowledge production )

  84. Elo said,

    November 28, 2007 at 6:56 am

    I’m a bit late to this discussion and you can call me Necromancer of dead posts if you want.

    Just a quick word to some commentators here: what made you think this article had anything to do with sociology ?

    Dave Holmes is not a sociologist. His PhD is in Nurse sciences, whatever that means. His paper is not recognized as a sociological publication. Postmodernists and poststrucuralists like our Dear Holmes here are cultists and Holmes himself is sticking Foucault’s ideas on everything he touches.

    Hardly science work. His intentions are unclear as a professor and researcher at the University of Ottawa. His career as a writer is more likely to be the object of his focus that understanding and explaining the social world.

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  86. certaintyprinciple said,

    March 2, 2010 at 7:02 pm

    I am puzzled as to why the detractors of this piece don’t get past the inflammatory title, be ‘good scientists’ and see that it makes some valid points about the limitations of EBM and the self-evident truth that having a single model for judging the validity of information is inherently likely to limit the furthering of understanding. What damages science most is scientific ‘certainty’ which is then inevitably and repeatedly shown to be wrong and which is why the general public have lost so much faith in science. It is this that allows quackery to flourish not the existence of quacks and taking a good hard look at our disciplines and our narrowness is the first step to redressing this.

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