Take that, you pesky microfascists…

December 12th, 2006 by Ben Goldacre in bad science, postmodernist bollocks | 89 Comments »

You may remember this little skirmish with the post-modernist posse, where evidence based medicine and the Cochrane library were described as fascist projects.

www.badscience.net/?p=284

It’s not entirely clear to me if this is a very elaborate joke, but it would appear that someone has bravely published responses to blog commenters in a scholarly academic article. In fact, as far as I can tell from the abstract below, someone has taken it upon themselves to respond to you blog commenters, in a scholarly academic article. [Edit: oh my god, somebody has sent me the pdf, they quote you and they use your silly made up screen names, it's like reading academic critique in a parallel fairy tale universe]

Archie Cochrane (left, with stylish Spanish gentleman) as a captain in the International Brigade c.1936.

If true this is surely the best Christmas present ever.

SCHOLARLY ARTICLE
Scientists, postmodernists or fascists?
Professor Alan Pearson RN MSc PhD FAAG FRCN1,2
International Journal of Evidence-Based Healthcare
Volume 4 Issue 4 Page 385 – December 2006
doi:10.1111/j.1479-6988.2006.00054.x
Volume 4 Issue 4

www.blackwell-synergy.com/doi/abs/10.1111/j.1479-6988.2006.00054.x

Abstract

The somewhat frenzied reaction to publication of a provocative, discursive paper titled ‘Deconstructing the evidence-based discourse in health sciences: truth, power and fascism’ by Holmes et al. in the International Journal of Evidence-Based Healthcare is both surprising and worrying. The paper is essentially a postmodernist critique of evidence-based healthcare. In the same issue of the journal in which the paper was published both the guest editorial and a response to the paper refute its claims. However, media coverage on the paper gave rise to numerous defensive responses that attacked the paper through claiming it represents ‘bad science’ or by disparaging the International Journal of Evidence-Based Healthcare, its Editor, its peer review processes or the organisation linked to the journal, the Joanna Briggs Institute. It is clear that those who mounted these attacks had no knowledge of the journal (or of the editorial and response refuting the claims made in the paper, published in the same issue) or its parent organisation; and none of them attempted to critique the paper in a scholarly fashion. This paper sets out to construct a scholarly argument to refute these claims and to consider why it is that those who support evidence-based healthcare and/or science chose to disparage a journal and an organisation that promotes and facilitates evidence-based approaches to healthcare – and the value of the Cochrane Collaboration – rather than developing a rigorous critique of the argument developed in the Holmes et al. paper. Although this response appears to be an attempt to silence dissenting views (and may, to some, suggest that the reference to microfascism in the paper in question may, indeed, have some validity) we conclude that the postmodernist critique of evidence-based healthcare embodied in the paper sets out criticisms that, though widespread in healthcare, can be challenged in a considered, scholarly way. The ill-informed, reactionary responses to it by the defenders of science make little contribution to the ongoing development of evidence to improve global health.

[If anyone can get a full copy of the article I'd very much like to see it. Fingers crossed that the whole thing is as good as the last sentence of that abstract!]


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89 Responses



  1. stever said,

    December 12, 2006 at 12:33 am

    hahaha

  2. Ben Goldacre said,

    December 12, 2006 at 12:39 am

    heh. responding to comments on teh interweb in an academic article indeed. i guess they don’t realise this means they officially lose.

  3. Ben Goldacre said,

    December 12, 2006 at 1:50 am

    International Journal of Evidence-Based Healthcare
    Volume 4 Issue 4 Page 385 – December 2006
    doi:10.1111/j.1479-6988.2006.00054.x
    Volume 4 Issue 4

    SCHOLARLY ARTICLE
    Scientists, postmodernists or fascists?
    Alan Pearson RN MSc PhD FAAG FRCN1,2
    Abstract
    The somewhat frenzied reaction to publication of a provocative, discursive paper titled ‘Deconstructing the evidence-based discourse in health sciences: truth, power and fascism’ by Holmes et al. in the International Journal of Evidence-Based Healthcare is both surprising and worrying. The paper is essentially a postmodernist critique of evidence-based healthcare. In the same issue of the journal in which the paper was published both the guest editorial and a response to the paper refute its claims. However, media coverage on the paper gave rise to numerous defensive responses that attacked the paper through claiming it represents ‘bad science’ or by disparaging the International Journal of Evidence-Based Healthcare, its Editor, its peer review processes or the organisation linked to the journal, the Joanna Briggs Institute. It is clear that those who mounted these attacks had no knowledge of the journal (or of the editorial and response refuting the claims made in the paper, published in the same issue) or its parent organisation; and none of them attempted to critique the paper in a scholarly fashion. This paper sets out to construct a scholarly argument to refute these claims and to consider why it is that those who support evidence-based healthcare and/or science chose to disparage a journal and an organisation that promotes and facilitates evidence-based approaches to healthcare – and the value of the Cochrane Collaboration – rather than developing a rigorous critique of the argument developed in the Holmes et al. paper. Although this response appears to be an attempt to silence dissenting views (and may, to some, suggest that the reference to microfascism in the paper in question may, indeed, have some validity) we conclude that the postmodernist critique of evidence-based healthcare embodied in the paper sets out criticisms that, though widespread in healthcare, can be challenged in a considered, scholarly way. The ill-informed, reactionary responses to it by the defenders of science make little contribution to the ongoing development of evidence to improve global health.
    Introduction Go to: GO down
    The postmodernist thinking that has characterised a number of academic disciplines in the last two or so decades of the 20th century – and is still alive and well in some quarters – has played an important role in creating new ways of developing ideas in the arts, science and culture. The relativism on which it is founded, and the ‘liberation’ from sacred cows it seeks, have a place in healthcare and health science. At its simplest (and it is far from simple!) postmodernism is a response to modernity – the period where science was trusted and represented progress – and essentially focuses on questioning the centrality of both science and established canons, disciplines and institutions to achieving progress. The nature of ‘truth’ is a recurring concern to postmodernists, who generally purport that there are no truths but multiple realities and that understandings of the human condition are dynamic and diverse. The notion that no, one view, theory or understanding should be privileged over another (or that no discourse should be silenced) is a tenet of postmodernist critique and analysis. Hlynka and Yeaman1 suggest that the postmodernist position is characterised by pluralism, searching for double meanings and alternative interpretations, distrust of grand theories and of established professions and their views and a commitment to the view that there are multiple truths. Postmodernist inquiry is grounded in the processes of deconstruction. Deconstruction, according to Hlynka and Yeaman involves considering concepts, ideas and objects as texts that are open to interpretation.1 To deconstruct such ‘texts’, postmodernists identify binary oppositions in them and attempt to elucidate how authentic these oppositions are and identify texts that are absent or ‘silenced’.
    In critiquing the health sciences, serious postmodernist scholars acknowledge the possibilities for the advancement of population health inherent in current medical and healthcare research methodologies, conceding that the empirical sciences pursue practical questions and that this has led to the eradication of many previously overwhelming illnesses, diseases and symptoms. Although this flies in the face of radical postmodernists who are cynical about all forms of scientific endeavour, many postmodern scholars concede that the delivery of complex care to sick people – or the promotion of health in a population – must take heed of empirical evidence. As Griffiths in his critique of a postmodernist critique of evidence-based practice says:2
    If I (as a practitioner) wish to know (for whatever reason) whether a treatment, which can be examined in a controlled trial, does in fact achieve a particular effect in order to help me decide how to act, no meaningful alternatives are on offer here . . . Is it possible that in rejecting the certainties promised by evidence-based practice that a refuge for sloppy thinking, laziness and poor practice might be created?
    Health and medical scientists, in confronting human suffering and in challenging the social and economic causes of health and illness, are not averse to the postmodernist perspective. Chan and Chan argue,3 for example, that ‘. . . if medicine does not respond to the ideas of postmodernism, which challenges the concepts of truth and our ability to be objective, it may become increasingly irrelevant to the needs of a changing society.’ But nurses, medical practitioners and allied health professionals recognise that multiple realities, for them, include the outcomes of the good science despised by hard-line postmodernists as well as the relative, multiple realities of people, communities and cultures.
    Many postmodern critiques of developments in the science of medicine, nursing and the allied health professions adopt a much more cynical view of the genuine attempts of health scientists to confront the challenges to human health of our era. Such critics are situated in a perspective that views everything as relative; considers no view as privileged over another; and argues that science and ‘rational’ theory fails to verify, falsify or otherwise justify a theoretical position outside a commitment to a range of empirically arbitrary and culturally embedded conceptualisations. This perspective is the basis of Holmes et al.’s provocative polemic asserting that modern evidence-based healthcare (EBHC) exemplifies fascist characteristics in that it ‘. . . serves to (re)produce the exclusion of certain forms of research’.4
    Deconstructing Holmes et al.’s ‘deconstructing the evidence-based discourse in health sciences: truth, power and fascism Go to: GO updown
    In their deconstruction, Holmes et al.4 (the authors, as I shall refer to from now on) claim that the ‘health sciences are colonised (territorialised) by an all-encompassing scientific research paradigm – that of postpositivism – 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.’
    van Zelm5 in the Editorial of the same issue of the journal in which the Holmes et al.’s paper appears, argues that the ‘fascist’ characteristics that the authors ascribe to Sacket et al.6 ‘. . . is not what Sackett et al. had in mind when they “invented” the term EBM!’ van Zelm goes on to suggest that EBHC is ‘. . . not about searching [for] “the truth”, using only randomised controlled trials or systematic reviews. This would lead to Evidence Biased Medicine!’ He describes EBHC as decision-making and says that ‘Simply applying evidence in any form (studies, guidelines, patient preferences, etc.) without critical thinking is not evidence-based practice. It is hazardous practice.’
    Also in this same issue of the journal is a response to it by Colin Holmes7 [no relation to the first named author of the paper!] Colin Holmes – to avoid confusion, I use his full name here – refutes the claim that the EBHC movement is a form of microfascism. He first asserts that ‘Any practice that steadfastly ignored “evidence” would be mere chaos, and what is in dispute is what should be counted as evidence and what value should be attached to it. However, in depicting the evidence-based practice movement as a single entity, the authors set up a straw man, and merely demonstrate their skill at knocking it down with barrages of entertaining verbosity.’ He goes on to describe how health scientists and health professionals who support evidence-based practice ‘. . . express a wide range of opinions about its role and importance, and have consistently laid it open for critical analysis and comment.’ He then proceeds to critique the basis of the paper and the conclusions it draws.
    The authors claim that evidence-based health sciences(sic) argue that clinical practice should be based on ‘scientific inquiry’ and 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.’ The authors’ interpretation of the ‘texts’ deconstructed – that is, the references cited – in relation to this assertion6,8 reflect their allegiance to a view that sees science as a movement that devalues all other forms of knowing and doing and their suspicion that, whenever the products of science are applied in practice, practitioners rely solely on it and separate themselves from other knowledge sources and there own subjective being.
    Proponents of the evidence-based approach make no such claims, nor can they be found in the ‘texts’ deconstructed by the authors. Sacket describes the evidence-based approach as ‘. . . the integration of best research evidence with clinical expertise and patient values’ (p. 1) [my emphases].6 In his paper critiquing the evidence-based practice movement, Traynor describes it in very different terms to those of the authors:8
    The evidence-based movements have become associated, fairly or unfairly, with one particular understanding of scientific evidence, the experimental method, and particularly the randomised controlled trial (RCT) and systematic reviews or meta-analyses of RCTs. Its adherents, however, strenuously deny methodological narrow-mindedness. They argue both that different problems require different research designs, for example cross-sectional studies may be required to address questions about the accuracy of a diagnostic test, and that rather than a dualism of valid and invalid evidence, there exists an evidence hierarchy. (p. 162)
    In asserting that evidence-based practice subscribes to, and attempts to enforce, an ideology of practice made up only of the products of science informed by no other form of knowledge, the authors reveal that their position is more of an ideological opposition to science and scientism, an attempt to develop an informed critique. In postmodernist terms, they assume a singular, unitary discourse (that is, they essentialise the concept) rather than identifying the competing discourses within the EBHC movement that, in themselves, expose health scientists and professionals as people attempting to deal with, on the one hand, ever increasing information (scientific, aesthetic, ethical, etc.) and on the other, demands for effective, appropriate and meaningful healthcare.
    Postmodernism asks the questions who is speaking; what is being said; what is not being said; and whose interests are being served? It is not difficult to conclude that the authors represent the hard-line, anti-science view, given only those components of the discourses that refer to the use of scientific findings are spoken about; the very clear references to the importance of considering the practitioner’s knowledge and judgement and the preferences and values of the patient present in the discourses surrounding EBHC are marginalised; and, thus, the interests of the authors (that is, the debunking of science and the role it plays in modern healthcare) are being served.
    Citing Traynor8 the authors claim that ‘. . . one of the requirements of the Cochrane database is that acceptable research must be based on the randomised controlled trial (RCT) design; all other research, which constitutes 98% of the literature, is deemed scientifically imperfect.’ This is simply not the case. The Cochrane Collaboration conduct systematic reviews of evidence of the effects of interventions and focus on the results of randomised trials that, by their very nature, attempt to identify cause and effect relationships through minimising, as far as is possible, bias. However, the findings of research that utilise other designs are not disregarded by Cochrane. Furthermore, the Cochrane Collaboration makes no claim that only evidence of effects is useful to practice.
    The authors also claim that evidence-based health sciences (EBHS), in promoting the RCT as the only valid research design to generate valid findings, represent such findings as the ‘truth’. They go on to assert that, ‘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.’ None of the ‘texts’ addressed by the authors adopt such a view; furthermore, to suggest that health professionals unquestionably subjugate their own knowledge and judgement assumes a level of naivity and lack of intelligence that disregards the sophistication of doctors, nurses and allied health professionals. Although Traynor8 speaks from a postmodernist perspective, he concedes that EBHC ‘. . . has touched nerves among a wide range of professionals and led to a great deal of controversy.’ (p. 167)
    As Colin Holmes7 succinctly puts it, ‘the authors have set up a “straw man” to knock down.’ Although there is merit in generating debate in relation to the role of science and the nature of evidence in relation to healthcare, the use of the term ‘fascism’ ‘. . . to refer to any structure that arises out of an ideology that excludes other forms of knowledge . . .’ ‘. . . seems an unnecessary misrepresentation of the concept and practice of fascism. Perhaps readers will, like me, remain unconvinced of its propriety, and will prefer to avoid the political overtones it inevitably conjures, and certainly to reject the explicit attempt to link the Cochrane initiatives to the fascism of Hitler and Mussolini.’ The use of the term fascist appears to have motivated the media to report on this paper; and to have triggered an almost immediate reaction from both the defenders of science and the proponents of EBHC. Fascism contemporarily refers, of course, to a system of government that is characterised by dictatorship, centralised control of enterprise and the repression of opposition. It is – of more importance when seeking to understand the basis of the reaction to the paper – also associated with the system of government adopted by Mussolini that is reviled in democratic societies. The reference to fascism, rather than the other poorly grounded criticisms in the paper, seems to have ‘touched a nerve’ for many.
    The response of ‘scientists’ Go to: GO updown
    Although it is not surprising that the language used by the authors generated media coverage, the response by some ‘scientists’ was unexpected. As well as describing the role that Archie Cochrane (the early proponent of evidence-based medicine) in opposing fascism as a volunteer in the Spanish civil war, many critics of the paper chose to discredit the journal in which it was published or its editor or organisational allegiance. The paper was published in a journal of the Joanna Briggs Institute (JBI), an EBHC organisation that conducts Cochrane Reviews; that promotes EBHC; that subjects all submitted papers to double blind peer review; and that published, in the same issue, an editorial refuting the conclusions of the paper, written by a researcher from the Dutch Institute for Healthcare Improvement with no association with the JBI and a response to the paper by a postmodernist scholar, again with no formal association with the Institute.
    Ben Goldacre, writing in the British Guardian newspaper,9 summarises the argument of the authors as ‘evidence-based medicine rejects anything that isn’t a randomised control trial; the Cochrane Library is the chief architect of this project; and this constitutes fascism.’ He rejects the argument, though conceding that evidence-based medicine is seen by many as ‘soulless, and algorithmic’ he asserts that the argument proffered by the authors is ‘. . . a foolish misunderstanding. Evidence-based medicine is about using quantitative information, in concert with all other forms of knowledge, sensibly, in a clinical context. It does not denigrate other forms of knowledge.’ This Guardian column links to a web site named ‘bad science’ (Available at: www.badscience.net/) – which filled up quickly with postings castigating the paper; not, though, with well argued critique of the paper, but largely with attacks on the journal. From the postings that appeared on August 20 2006, it was clear that the contributors had no knowledge of the JBI or the journal; that very few had attempted to locate the journal issue; and that this lack of detail did not weigh in their responses as information worth pursuing. As a result, none were aware that an editorial and a response to the paper – both refuting the conclusions drawn in the paper – were published alongside it. None of the contributors to the site revealed their names or contact addresses. ‘simongates’, for example asked ‘What on earth did the editors of this journal think they were playing at? Maybe it was a mischievous prank on their part to see what reaction they could provoke? Surely they could not have thought that this was a contribution to knowledge or intellectual debate? Can I urge proper scientists to write to the editor of this journal and let them know their thoughts? I certainly will.’ Soon after this posting, ‘ceec’ posted ‘I looked up the journal . . . on PubMed and Web of Knowledge where it doesn’t appear at all. It may be a bit early to dismiss the whole of “social science” on the strength of this particular article.’ This was quickly responded to by ‘Dr Aust’ who said ‘Interested by ceec’s non-finding of this journal anywhere. Presumably this means it doesn’t have a journal impact factor?’ In her or his second posting, ‘ceec’ answered ‘The journal is new in its current incarnation but it says it was previously called “JBI reports”. Just to be clear, neither the current nor the old title appear in any of the following: PubMed (database of abstracts in medical and related journals) Web of Knowledge (covering social science, arts, science, etc. as well as medicine) Union List of Serials (a list of all journals held by the constituent colleges of the University of London). This suggests to me that the journal is not used by academics in any meaningful sense.’ Still on the same day, ‘Dr Aust’ adds ‘The journal states that work in it is “fully peer reviewed”, but it appears to be the house journal of a collaborating network of centres for research in various Univs – so perhaps it is a network of people who know each other refereeing each others’ work, which is not quite standard peer review. They do say ‘blind peer review’, but under the circumstances I would doubt the blinding (i.e. referees don’t know the authors’ names) would be that effective. The members of the JBI all appear to be University centres for para-medicine subjects . . .’ Adding to this growing line of disregard for the journal, ‘superburger’ said ‘The very fact that I can’t get access to the journal from within a major university (with medical school) says a fair bit.’
    The failure of any of these contributors – apparently, people from the scientific and scholarly communities intent on exposing bad science and protecting and promoting ‘good’ science – to critique the substance of the paper; they focused solely on attempting to discredit an established EBHC organisation and its journal. Such a response may explain the origins the postmodernist suspicion of science as, in Foucauldian terms, a ‘regime of truth’ in that these scientific commentators appear to be asserting that they know the source of ‘good’ scientific critique (and therefore, are privy to what is the truth) – and, because they are not aware of the source, it is unworthy of serious critique.
    After the posting of numerous responses – all similar in their uninformed disdain of the journal and lack of substantive critique of the paper in question, ‘katem’ posted the editorial and response to the paper on August 23 2006. In response superburger said ‘That response was excellent. I’ve honestly never seen such a withering put down in any “serious” science journal. The letter throws back all the jargon and explains, quite clearly, why the original article was for the most part drivel.’ Clearly, the response (perhaps because here, for the first time on this site, was a robust, scholarly critique of the substance of the paper) was well received, but the fact that it appeared in the journal is interpreted, it would seem, as confirmation that the journal is therefore not a ‘ “serious” scientific journal’ because no such journal would publish such a ‘withering put down.’ The so-called withering put down, in scholarly circles, would be regarded more as a considered, well-argued critique of a postmodernist polemic designed to generate discussion and debate; a characteristic, it could be argued, of good science; and the precursor of many scientific discoveries in the past. If ‘serious’ scientific journals don’t publish rigorous critiques of the papers they publish that are contentious, why would this reflect ‘seriousness’ rather than a failure to ensure that opposing arguments are considered with the scientific community that subscribe to such a journal!
    Some hours later, ‘Dr Aust’ responded with: ‘I think the message of most of the posts on this and the preceding thread was primarily that the Dave Holmes et al. article was a wilfully obscure, consciously jargon-led rant, and that any real point it was making was almost totally obscured by the language and could have been expressed much more clearly in many less words. The critique by Colin Holmes (many thanks to “katem” for providing the full text) says all this admirably, sets out succinctly in about 100 words what Dave Holmes et al. take pages and pages to declaim, and then refutes the arguments nicely.’ At no point does an admission by any contributor appear on the page that, perhaps, the numerous postings may have been overly defensive; that they may have been based on reading the paper out of context (that is, without the editorial and response); or that the damning judgement of the journal may have been somewhat uninformed.
    Discussion Go to: GO updown
    The Holmes et al. paper is a polemic, grounded in the postmodernist critique of science and modernity, published in the official journal of the JBI. JBI is an international organisation that promotes and facilitates EBHC. The work of the Cochrane Collaboration – the focus of the critique by Holmes et al. – is strongly supported by JBI; indeed, JBI and its collaborating Centres conduct systematic reviews of the effects of interventions through Cochrane Review Groups; JBI actively encourages allied health professionals, nurses and medical practitioners to use the Cochrane Library; some JBI staff are office bearers in the Cochrane Qualitative Research Methods Group and/or members of Cochrane Review Groups; and JBI hosts the Cochrane Qualitative Research Methods Group Website. Thus, in labelling the proponents of Cochrane as ‘fascist’, the paper in question is criticising JBI as much as it does the Cochrane Collaboration. As Colin Holmes argues, in his response to the paper, JBI has invested much of its resources in examining the nature of evidence for healthcare and in promoting pluralistic approaches to evidence-based practice. JBI supports the Cochrane Collaboration’s contention that, when considering the effects of interventions (such as pharmaceuticals, surgical techniques, etc.), the RCT represents the most valid evidence in that it seeks to establish the effect(s) of a specific intervention, in a specific population, on specific outcomes when compared with specific alternatives through attempting to limit bias through randomisation and the ‘blinding’ of those who administer, receive and evaluate the intervention. However, JBI contends that there are evidence interests other than evidence of effects. The JBI ‘Model of Evidence Based Health Care’10 refers to the ongoing debate on the meaning of evidence for healthcare and suggests that “Evidence” is a complex concept that warrants examination as it means different things to different people. The term ‘evidence’ is used in the JBI model to mean the basis of belief; the substantiation or confirmation that is needed in order to believe that something is true.11 The JBI Model accepts the RCT as a legitimate source of evidence when cause and effect relationships are considered but it unambiguously asserts that health professionals seek evidence to substantiate the worth of a very wide range of activities and interventions and thus the type of evidence needed depends on the nature of the activity and its purpose. Flowing from this assertion, the model addresses four evidence interests; feasibility, meaningfulness, appropriateness and effectiveness. Feasibility is the extent to which an activity is practical and practicable; appropriateness is the extent to which an intervention or activity fits with or is apt in a situation; meaningfulness relates to the personal experience, opinions, values, thoughts, beliefs, and interpretations of patients or clients; and effectiveness is the extent to which an intervention, when used appropriately, achieves the intended effect. Discourse (or narrative), experience and research are identified as legitimate sources of evidence or knowledge for healthcare practice. Any indication that a practice is effective, appropriate, meaningful or feasible – whether derived from experience or expertise or inference or deduction or the results of rigorous inquiry – is regarded as a form of evidence in the model. (The results of well designed research studies grounded in any methodological position are seen to be more credible as evidence than anecdotes or personal opinion; however, when no research evidence exists, expert opinion is seen to represent the ‘best available’ evidence)
    A major flaw in the Holmes et al. paper is the failure of the authors to consider this essentially pluralistic approach of JBI within the EBHC movement – even though they submitted this paper to the official journal of JBI; it suggests that the authors have focused on one discourse surrounding EBHC and assumed that no other, competing discourses exist within the EBHC movement. The JBI model responds to most of the arguments embodied in the critique of EBHC and reflects the robust debate within the health professions and health sciences. The Holmes et al. paper rehearses therefore arguments that abound across the health professions. Though not situated within the postmodernist position – and not, therefore conveyed in the language used by postmodernists – clinicians of all persuasions posit similar objections to EBHC to those developed in the paper. Publishing this paper in a journal that is read by health professionals who favour EBHC creates a space to consider the issues raised by its critics and to address them with a degree of rigour. JBI is not – as the critics who registered their protestations on the ‘bad science’ web site describe it – a group of ‘para-medicine’ zealots, without intelligence, qualifications or status. It is an international, multidisciplinary group of health scientists and health professionals that supports the Cochrane Collaboration and contributes, in its own way and through Cochrane Review groups, to the improvement of global health. The International Journal of Evidence-Based Healthcare is not – as the same ‘bad science’ critics claim – run by a group of ‘mates’ who referee each others work. JBI reviews are subjected to internal peer review (like Cochrane) but they are submitted to further, blind review by reviewers external to JBI (many are from the Cochrane Collaboration). From the postmodernist perspective, it is appropriate to consider the underlying premises and purposes not only of Holmes et al. and their claim that the EBHS demonstrate the characteristics of microfascism; but also of the ‘scientists’ who think it is legitimate to respond to a paper such as this by regarding it as science (which it is not) and by supporting their disagreement of it by seeking to bring JBI and the International Journal of Evidence-Based Healthcare into disrepute.
    Conclusion Go to: GO updown
    By its very nature, an argument of the kind developed by Holmes et al. in ‘Deconstructing the evidence-based discourse in health sciences: truth, power and fascism’ is polemical in that its critique of science and the institutions and practices associated with it arises from suspicion and a deep sense of cynicism.4 The fact that such arguments are usually couched in language that incites a reaction is entirely in accord with the tradition of deconstruction. However, Colin Holmes has shown that a considered and logically argued response is also possible.7
    Those of us who are part of the EBHC movement are not immune from criticism and, if we have a clinical background, are exposed to it continuously from our critical, expert clinical colleagues. Silencing viewpoints we do not like by undermining people and organisations, rather than examining the substance of opposing views and engaging in considered debate, adds fuel to the suspicion of those who revile science and its role in healthcare.

    References Go to: GO up
    1. Hlynka D, Yeaman RJ. Postmodern Educational Technology. ERIC Digest No. EDO-IR-92-5. Syracuse, NY: ERIC Clearinghouse on Information Resources, 1992.
    2. Griffiths P. Evidence-based practice: a deconstruction and postmodern critique: book review article. Int J Nurs Stud 2005; 42: 355–61.
    CrossRef Abstract MEDLINE Abstract ISI Abstract
    3. Chan JJ, Chan JE. Medicine for the millennium: the challenge of postmodernism. Med J Aust 2000; 172: 332–4.
    MEDLINE Abstract ISI Abstract
    4. Holmes D, Murray SJ, Perron A, Rail G. Deconstructing the evidence-based discourse in health sciences: truth, power and fascism. Int J Evid Based Healthc 2006; 4: 180–7.
    SYNERGY Abstract
    5. van Zelm R. The bankruptcy of evidence-based practice? Int J Evid Based Healthc 2006; 4: 161.
    SYNERGY Abstract
    6. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence Based Medicine: How to Practice and Teach EBM, 2nd edn. London: Churchill Livingstone, 2000.
    7. Holmes C. Never mind the evidence, feel the width: a response to Holmes, Murray, Perron and Rail. Int J Evid Based Healthc 2006; 4: 187–8.
    SYNERGY Abstract
    8. Traynor M. The oil crisis, risk and evidence-based practice. Nurs Inq 2002; 9: 162–9.
    SYNERGY Abstract MEDLINE Abstract
    9. Goldacre B. Objectionable ‘objectives’. The Guardian Saturday August 19, 2006.
    10. Pearson A, Wiechula R, Court A, Lockwood C. The JBI model of evidence-based healthcare. JBI Rep 2005; 3: 207–16.
    SYNERGY Abstract
    11. Miller S, Fredericks M. The nature of ‘evidence’ in qualitative research methods. Int J Qual Methods 2003; 2: Article 4. Accessed 1 Sep 2005. Available from www.ualberta.ca/~ijqm

    International Journal of Evidence-Based Healthcare
    Volume 4 Issue 4 Page 385 – December 2006

  4. Ben Goldacre said,

    December 12, 2006 at 1:51 am

    International Journal of Evidence-Based Healthcare
    Volume 4 Issue 4 Page 263 – December 2006

    ==============================================

    International Journal of Evidence-Based Healthcare
    Volume 4 Issue 4 Page 392 – December 2006
    doi:10.1111/j.1479-6988.2006.00050.x
    Volume 4 Issue 4

    LETTER TO THE EDITOR
    How to grab a headline: lots of smoke and little meat. (Response to Holmes et al.)
    Tom Jefferson MD
    Dear Editor:
    Reading the diatribe by Holmes and colleagues it was with some surprise that I learned that I am a microfascist. From what I understand from the rather confused and jargon-laden description that Holmes and colleagues give, I have come to gain this dubious honour from being a member of an ‘all-encompassing scientific paradigm (postpositivism)’, which ‘comes to exclude alternative forms of knowledge': in other words I am a member of the Cochrane Collaboration.
    The authors reach this conclusion on the basis of a mixture of imprecise use of terms and sheer falsehoods which belie the ‘scholarly’ tag given to their paper. Let me start my response by dealing with the myths and finish with the philosophical content. The Cochrane Library is not ‘a collection of articles’ but is a searchable resource which is organised in a structured fashion. At its core is the database of systematic reviews (‘Cochrane reviews’). Cochrane reviews cover different topics and different disciplines. Readers can gain uptodate synthetic knowledge of the effectiveness and harms of interventions as different as Echinacea for the common cold1 and helmets to prevent injuries to motorcyclists.2 Had Holmes and colleagues bothered to do their homework they would have discovered that some reviews are almost exclusively based on non-randomised evidence. An example is our review of the effects of influenza vaccines in the elderly. We included 96 datasets in the review, only 5 of which were from randomised controlled trials – so much for the ‘dictatorship’ of the randomised controlled trial.3
    Holmes and colleagues in the rush to carry out an epistemiological lynching of the Collaboration and its work have also missed some of its unique achievements. The first and perhaps most remarkable is the pluralistic quality of what we do. The Collaboration works as an international network whose sole purpose is to prepare and maintain systematic reviews. Over the years I (a doctor) have worked with biologists, engineers, librarians, nurses, statisticians, economists, members of the public, school children, journalists, physics graduates and homeopathic practitioners to prepare Cochrane reviews. We do not care who you are or what your politics, ethnic background or job are. We do reviews.
    I wonder if Holmes and colleagues are aware that our ‘microfascist organisation’ has an active consumer network and no Cochrane review or protocol are published without the comments of one of more consumers.
    To my knowledge the Collaboration is the first of its kind to publish protocols, then the fully prepared review and then its regular updates. Once the review is published on the website anyone can send comments which must be answered within 6 months by the authors. The comments and the response are added to the review and represent a permanent record. Reviews are living research (our review of amantadine and rimantadine for influenza has just gone through its fourth update since first publication in 1999).4 Having all evidence synthetised and weighted by its quality should help any readers make informed choices, perhaps this is why Holmes and colleagues find our work so threatening.
    Reviewers collaborate with one another, they do not compete, in an effort to maximise scarce resources. If two reviewers in different parts of the globe want to prepare a review on the same topic they are invited to collaborate, rather than duplicate their work. In the modern research world this is a revolution, as it changes radically our way of doing things. Instead of working in isolation competing for space on prestige journals, we have an international pluralistic network collaborating from the idea stage of a review. The concept of a monolythic organisation subverting science put forward by Holmes and colleagues made me giggle. A few years ago when we had the first of our periodic elections to select our representatives on the Cochrane Collaboration Steering Group there was quite a lengthy friendly debate on who was entitled to vote. You see, dear readers of this letter, we do not carry party cards and do not levy contributions from our members (however, defined).
    The final myth: could the authors please point me to where I can get ‘institutional promotions, accolades, public recognition and state contracts of all kinds’? In 13 years of systematic reviewing I have come across very few of these. The reality is a head-on collision between available evidence and people’s prejudices, opinions and decisions.
    Now to the philosophical part of the Holmes paper. In modern times from Bacon to Kuhn and Lakatos everyone agrees that the purpose of science is to better man’s lot.5 The Collaboration does this in an epidemiological context which, although predominantly based on probabilistic induction, is compatible with falsificationsim, Kuhn paradigms of the evolution of science and in fact is very similar to Feyerabend’s epistemiological anarchy in its practical application. How else could one explain the power of intercessionary prayer6 and the use of Echinacea1 as topics of Cochrane reviews? We are well aware that evidence and human observation is fallible which is why we strive to minimise bias rather than follow the utopia of eliminating it. To stay with Thomas Kuhn, we do not care what paradigm is chosen, we care about what works.

    Tom Jefferson MD
    References Go to: GO

    1. Rivetti D, Jefferson T, Thomas R et al. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev 2006. Art. No.: CD004876.pub2. 10.1002/14651858.CD004876.pub2.
    2. Liu B, Ivers R, Norton R, Blows S, Lo SK. Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev 2003. Art. No.: CD004333.pub2. DOI: 10.1002/14651858.CD004333.pub2.
    3. Linde K, Barrett B, Wölkart K, Bauer R, Melchart D. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2006. Art. No.: CD000530.pub2. DOI: 10.1002/14651858.CD000530.pub2.
    4. Jefferson T, Demicheli V, Di Pietrantonj C, Rivetti D. Amantadine and rimantadine for influenza A in adults. Cochrane Database Syst Rev 2006. Art. No.: CD001169.pub3. DOI: 10.1002/14651858.CD001169.pub3.
    5. Chalmers AF. What is This Thing Called Science? Milton Keynes: The Open University Press, 1980.
    6. Roberts L, Ahmed I, Hall S. Intercessory prayer for the alleviation of ill health. Cochrane Database Syst Rev 2000. Art. No.: CD000368. DOI: 10.1002/14651858.CD000368.

    International Journal of Evidence-Based Healthcare
    Volume 4 Issue 4 Page 392 – December 2006

    ==============================================

    International Journal of Evidence-Based Healthcare
    Volume 4 Issue 4 Page 394 – December 2006
    doi:10.1111/j.1479-6988.2006.00049.x
    Volume 4 Issue 4

    LETTER TO THE EDITOR
    Towards an understanding of the politics of ‘evidence': a response to Dr Jefferson, MD
    Dave Holmes RN PhD,1 Stuart J Murray PhD,2
    Amélie Perron RN PhD (cand.),1 and Geneviève Rail PhD1
    Given the mass of evidence, there is no plausible hypothesis but reality. Given the mass of evidence to the contrary, there is no solution but illusion.
    Jean Baudrillard1
    Dear Dr Jefferson:
    Thank you for your response to our paper. Remarkably, you raise the racist, hateful spectre of lynching. To be clear: we, the authors, are far from an angry lynch mob, real or illusionary. Lynching, in the strongest sense of this term, was a racist murderous practise of the Southern United States until the mid-twentieth century; it sought black submission through terror tactics; and it was often ‘legitimated’ though perverse appeals to patriotism and divine will. Indeed, the lynching of blacks was often tolerated or even unofficially sanctioned precisely because of an ideological refusal to engage in critical political debate – an unwillingness to interrogate those rigid political hierarchies by which white supremacy was the prevailing ‘regime of truth’.
    If nothing else, the ‘meat’ of our paper is not to reduplicate but to expose rigid political hierarchies and to engage in critical political debate. We argued that the evidence-based movement (EBM) is part of a wider political regime of truth; that it relies on potentially dangerous hierarchies, such as the Cochrane taxonomy; and that it ideologically refuses to critique the deeper terms of its own ‘legitimacy’. As responsible researchers, we believe it is our ethical and scholarly duty to question the norms and constraints that govern EBM’s research paradigm and epistemological commitments. In this regard, it would be mistaken to claim that we are opposed to ‘evidence’. We ask deeper and more exigent questions: Within EBM’s paradigm, what or who decides what will count as evidence? And what are the epistemological and ontological underpinnings of such decisions? Furthermore, what are the agendas that motivate funding agencies in their support of this research? Our arguments are clearly aligned with Denzin’s2 assertion at the First International Congress of Qualitative Research:
    The congress is a call to the international community of qualitative researchers to address the implications of the attempts by federal funding agencies to regulate scientific inquiry by defining what is good science. Around the globe governments are enforcing evidence-based, biomedical models of inquiry. These regulatory activities raise fundamental philosophical epistemological, political and pedagogical issues for scholarship and freedom of speech in the academy. (p. iv)
    To be more specific, Dr Jefferson, in your letter you state that the Cochrane Library is a ‘database of systematic reviews’ and that ‘all evidence’ is ‘synthetised and weighted by its quality’. While you mock our paper for its use of ‘jargon-laden’ terminology, it is only fair to ask, in turn: what is ‘synthetisation’ and by what standards are these reviews ‘systematic’? Moreover, what will qualify as ‘quality’? Your declarations of ‘pluralism’ notwithstanding, the very process by which diverse research is ‘organised’, ranked, and endorsed as ‘systematic’ must itself be interrogated. Who decides? You mention the ‘friendly debate’ over who is ‘entitled to vote’ for representatives of the Cochrane Collection Steering Group, but this itself is hardly evidence of pluralism and democracy – this group was already highly self-selected. The ‘gold’ standard for truth according to the Cochrane taxonomy remains the randomised controlled trial. In this manner, research is rigidly hierarchised, e.g. the Cochrane taxonomy denigrates clinical expertise, and similarly, qualitative research based on participants’ narratives is ‘systematically’ ranked lower in value as ‘evidence’. To be sure, none of this is to dispute the goodwill or noble intentions of researchers or practitioners; rather, it is to hone in on the deleterious effects of their working paradigms and evaluative templates. As an ‘international network’, the real danger lies in the systemic or global application of such research: paternalistically, it is extended to systems in which it is sometimes woefully inappropriate.
    It would be disingenuous to dismiss our argument as unscholarly just because it is controversial and disrupts the status quo. To repeat, we do not wish to do away with ‘evidence’, to subvert one hierarchy only to replace it with another, more ‘utopian’, one. The purpose of our critique was to spark epistemological and political debate over the implicit paradigms that impose a dangerously narrow and rigid system of ‘truth’, and impose it universally. To overlook the effects of research paradigms and their associated epistemologies is a major flaw in the Cochrane taxonomy.3-7 Instead, we argue that researchers ought to encourage diverse and pluralistic paradigms and to eschew the rhetoric of the ‘average patient’, which is potentially totalising. And so while we might agree that the purpose of science is to better man’s – and woman’s – lot, the critical ethical question that must be debated is: how? and at what cost?
    In your final sentence, Dr Jefferson, you state that you favour ‘what works’ and ‘do not care’ about the paradigm itself. But this is to wilfully ignore the real effects of the paradigm; in the name of efficiency, it says that the ends justify the means. This is symptomatic of EBM and the Cochrane taxonomy. We contend that such a view promotes a dangerous ideology, one that threatens to reproduce the justificatory rhetoric of human pharmaceutical testing in developing nations and of eugenic programmes intended to ‘better man’s lot’, to offer two gruesome instances. This, too, must be admitted as ‘evidence’, however, repugnant. Research is a political enterprise, and we must not recoil from this reality.

    Dave Holmes RN PhD,1 Stuart J Murray PhD,2
    Amélie Perron RN PhD (cand.),1 and Geneviève Rail PhD1
    References Go to: GO

    1. Baudrillard J. Screened Out. New York: Verso, 2002.
    2. Denzin NK. First International Congress of Qualitative Inquiry – Official Program. Campaign-Urbana: University of Illinois, 2005. Accessed 20 August 2006. Available from: www.c4qi.org/qi2005/Program1.pdf
    3. French P. What is the evidence on evidence-based nursing? An epistemological concern. J Adv Nurs 2002; 37: 250–7.
    SYNERGY Abstract MEDLINE Abstract ISI Abstract
    4. Staller KM. Railroads, runaways and researchers: returning evidence rhetoric to its practice base. Qual Inquiry 2006; 12: 503–22.
    CrossRef Abstract ISI Abstract
    5. Traynor M. The oil crisis, risk and evidence-based practice. Nurs Inquiry 2002; 9: 162–9.
    SYNERGY Abstract MEDLINE Abstract
    6. Walker K. Why evidence-based practice now?: a polemic. Nurs Inquiry 2003; 10: 145–55.
    SYNERGY Abstract MEDLINE Abstract
    7. Winch S, Creedy D, Chaboyer W. Governing nursing conduct: the rise of evidence-based practice. Nurs Inquiry 2002; 9: 156–61.
    SYNERGY Abstract MEDLINE Abstract

    International Journal of Evidence-Based Healthcare
    Volume 4 Issue 4 Page 394 – December 2006

    ==============================================

    International Journal of Evidence-Based Healthcare
    Volume 4 Issue 4 Page 396 – December 2006
    doi:10.1111/j.1479-6988.2006.00048.x
    Volume 4 Issue 4

    LETTER TO THE EDITOR
    Some comments on the problems and merits of the evidence-based practice
    Massimiliano Aragona MD
    Dear Editor:
    I found the discussion on the limits of evidence-based practice for healthcare (EBP) very interesting and stimulating. I think that the decision of the editorial board of the International Journal of Evidence-Based Healthcare to publish Holmes et al.’s1 critique was a sign of wisdom and at the same time the best implicit answer to their accusation of totalitarism. The polemic tone of the discussion that followed, together with the reciprocal accusation of using an exclusionary language and the use of terms such as fascism and totalitarism were useful to attract the attention of the international scientific debate. However, I’m afraid that at the same time polemical emphasis may risk to hide the main problems of EBP, and this is the reason that solicited this letter.
    First, Holmes et al.1 are right when they write that EBP tends to be so much dominant and powerful that alternative views encounter many difficulties to find space in official scientific journals. They consider this fact as a sign of fascism. However, who said that science must be a democratic activity? In his influential book Thomas Kuhn2 showed that science is an activity based on a dominant paradigm that has its own language and methods. One of the consequences of practising what Kuhn calls ‘normal science’ is to marginalise alternative views. We may call it fascism if we like, but this is how science works and I don’t see here a risk for the democracy of a country as it was in the case of Mussolini. The two conditions appear incommensurable and the problem of the dominance of EBP is mainly a intrascientific problem.
    Second, in the kuhnian model the dogmatic application of the paradigm is in itself the main activity that lets ‘anomalies’ arise. Usually it is the emergence of anomalies and the consequent crisis of the dominant paradigm that smooth the way for scientific revolutions. For example, this is what is now happening in psychiatric nosology.3 I don’t know examples of scientific revolutions due to a free proliferation of multiple equally valued theories.
    Third, EBP and particularly randomised controlled trials (RCT) are the contemporary statistical refinement of empirical methods that date back at least to the Sixteenth Century’s eminent figure of Francis Bacon. Of course it is not forbidden to radically change methods; I think that they are not more eternal than theories which we all know are periodically revolutionised. However, those used in EBP are the most valued empirical methods of our scientific era and new methods that pretend to substitute them should prove to have higher efficacy.
    Despite these general considerations might appear as a critique to Holmes et al.’s work,1 I think that their paper was very useful because it solicited a critical debate on the limits of EBP. A few points appear particularly problematic and need to be focalised.
    First, to unveil the metaphysical nucleus of a dominant paradigm (the authors focalised their attention on the positivist assumptions of EBP) is necessary, because scientists applying the paradigm are usually unaware of its basic assumptions and tend to reify it.
    Second, what we mean with ‘evidence’ needs to be clarified. In fact, we often use this term synonymously with ‘proof’ or ‘fact’. However, after the Nineteenth Century’s abandonment of the idea of truth in science, we cannot continue to scotomise what philosophers of science have called ‘the theory-ladenness of scientific observations’.
    Third, it is true that journals dedicated to theoretical discussions are a large minority and that the journals with high impact factors prefer quantitative research. More journals dedicated to qualitative discussions and interdisciplinary dialogues would be welcomed.
    Fourth, Holmes et al.1 lament that EBP acts as a mechanism to impose the dominant paradigm. In his reply Holmes4 stressed that this is not true in practice, because the clinical establishment is reluctant to change practices following RCT evidence. However, when he writes that there is ‘a gap between what ought to be done according to the evidence and what is actually done’ (p. 188) he implicitly admits that EBP must be normative (it says how practice ought to be). This is a very critical point: is EBP justified when it pretends to say to clinicians what they should do? Let we consider the following points.
    First, Amsterdamsky5 clearly showed that the success of a paradigm is strictly connected also with ‘external’ factors (political, sociological and economical). We all know that RCT have costs, and thus it is more likely that more RCT will be performed in fields that interest the pharmaceutical industry that sponsor them. Accordingly, more RCT are performed for new drugs and for pathologies which are enough common to allow good financial returns. Older drugs and rare pathologies are usually understudied, and consequently less evidence is available for them.
    Second, sponsors sometimes influence the way RCT are designed and therefore their results. For example, new antipsychotics that must show to be better tolerated than classic antipsychotics may be tested versus high doses of haloperidol (that at high doses constantly presents a dramatic increase of extrapyramidal side-effects). This is above all an ethical problem, but it is also a practical bias for the evaluation of RCT.
    Third, RCT that prove that a therapy is efficacious are more likely to be published than trials showing negative results. Even when negative results are published, they tend to appear on journals with lower impact factors. Accordingly, positive results are more numerous and more widely known than negative results.
    In conclusion, due to these three serious biases of research that follows EBP requirements, clinicians should be alerted that EBP results are informative (indeed, meta-analyses and systematic reviews are the best available means for this scope) but cannot pretend to be normative (therefore practice guidelines should be considered with caution). The reason is logical: evidence-based findings say that something works, but they cannot say anything about the possible existence of something else that works as well but that was not studied with the same methods. If clinicians are aware of the limits of EBP it ceases to be dangerous and to fight good scientific methods become nonsensical. The real problem is not to struggle against EBP but to enlarge our knowledge in areas that EBP overlooked and on problems that need to be studied with other methods. To harmonise knowledge acquired with different methods a perspectivist view could be useful and it could share with EBP the same pragmatic and scientific exigencies.

    Massimiliano Aragona MD
    References Go to: GO

    1. Holmes D, Murray SJ, Perron A, Rail G. Decostructing the evidence-based discourse in health sciences: truth, power and fascism. Int J Evid Based Healthc 2006; 4: 180–6.
    SYNERGY Abstract
    2. Kuhn TS. The Structure of Scientific Revolutions. Chicago, IL: The University of Chicago Press, 1962.
    3. Aragona M. Aspettando la rivoluzione. Oltre il DSM-V: le nuove idee sulla diagnosi tra filosofia della scienza e psicopatologia. Roma: Editori Riuniti, 2006.
    4. Holmes CA. Never mind the evidence, feel the width: a response to Holmes, Murray, Perron and Rail. Int J Evid Based Healthc 2006; 4: 187–8.
    SYNERGY Abstract
    5. Amsterdamsky S. Between History and Method. Dordrecht: Kluwer Academic Publishers, 1992.

  5. Ithika said,

    December 12, 2006 at 2:52 am

    I have never had to wade through so much vapid, contentless drivel since… well, since you posted the original article the first time round, actually. I like how their response to the “letter to the editor” starts off with an immediate tangent about the racist overtones of lynchings. It’s just so obvious a tactic this has *got* to be fake.

    Surely?

  6. superburger said,

    December 12, 2006 at 6:56 am

    I’m confused. A ‘genuine’ academic journal is publishing blog-posts within it’s pages?

    So if I get my mates to agree with me on something enough on myspace, I can get in Nature? w00t. All of your journalz is p0wned by us.

  7. igb said,

    December 12, 2006 at 7:14 am

    There’s a marvellous essay by Clive James, which he (rightly) regards as one of his best, in which he eviscerates a biography of Malcolm Muggeridge and, then, the subject of the bio.

    The book he’s skewering is by a Law lecturer at some minor Canadian university. Quoting some ludicrous par in which the author dismisses the totality of economics, James writes “Students of law at [institution] will be familiar with [author's] wide range, but for those of us in the provinces it is all a little daunting”.

    Now yes, he’s being an LRB snob, and many would say it’s inappropriate for an Australian to sneer at Canadians for being provincial. But the basic point is that if you trail a load of letters after your name, hailing from a minor institution and writing for a minor journal, you look like what you are: the figure of fun in an early Howard Jacobson novel.

    Slyly accusing everyone who doesn’t agree with your modish ideas of being eugenicist members of the Ku Klux Klan, and accusing of fascism a man who fought in the International Brigade, is probably what passes for academic discourse in the boondocks. But for the rest of us, it just looks hateful. One might just as easily point out that French is a language intimately tied to Fascism, especially in velodromes, and therefore anyone with a grave accent in their name is a Vichy collaborator.

    The level of intellect can be deduced from the fact that in their world, PhD(cand) is a post-nominative qualification. It isn’t. As the journal in question doesn’t figure in any sensible impact analysis, the authors cite bogus qualifications and the text is semi-literate even by the standards of modern critical discourse, the best thing to assume is that the JBI is either a hoax or a bunch of charlatans, mark their work as meaningless and move on. Publish nonsense, be dismissed as an institution that does rubbish: life’s about choices, and the JBI has made theirs.

  8. Rob K said,

    December 12, 2006 at 7:37 am

    I wonder if the authors of the original paper have noted the contrast between their eagerness to label others as “fascists” and the hysterical offence that they take when someone uses the word “lynching” by someone criticising their work.

    Rob

  9. Rob K said,

    December 12, 2006 at 7:38 am

    I wonder if the authors of the original paper have noted the contrast between their eagerness to label others as “fascists” and the hysterical offence that they take when someone criticising their work uses the word “lynching”.

    Rob

  10. AitchJay said,

    December 12, 2006 at 7:58 am

    “Professor Alan Pearson RN MSc PhD FAAG FRCN1,2″

    Tell me RN does not stand for Registered Nurse.

    Please.

  11. SciencePunk said,

    December 12, 2006 at 8:46 am

    It must be heartbreaking when you try so hard to be controversial, and the only rebuke you get worth replying to is found in the informal comments section of a weblog.

  12. warumich said,

    December 12, 2006 at 9:02 am

    Unbelievable! Of course it is completely fine to write a scholarly article on internet forums or blogs, but you’d have to follow at least some methodology, not cherry-picking your evidence. There were plenty of people who posted at least half-hearted defences of the paper, and some (even Dr Aust at some point, if I remember), who conceded that some points in that paper were worth making, but criticising it for being wilfully obscure.
    Pearson is wrong to claim that we were “seeking to bring JBI and the International Journal of Evidence-Based Healthcare into disrepute.” In the absence of free journal access for everyone, people can only speculate what else is in the journal, so of course nobody noticed the editorial at first. If you’ve never heard of a journal, any academic (and I bet Pearson does the same) goes through listings like the WoK to find out more about it’s reputability. If it can’t be found, and if even a major university with medical school doesn’t subscribe to it (mine doesn’t either), it’s not a good sign. The confusing array of journals and crank publications posing as journals is an unfortunate facet of academic life I teach to first-year undergraduates.
    To bring Foucauldian power-relationships into this is preposterous.
    But since you’re obviously reading this website, I’ll tell you what a Foucauldian power relationship IS: You see, the reason why I choose to stay anonymous is because, as a junior sociologist, it is always possible that I get someone like you on my interview panel for my next job application.

  13. Gleamhound said,

    December 12, 2006 at 9:16 am

    “The failure of any of these contributors – apparently, people from the scientific and scholarly communities intent on exposing bad science and protecting and promoting ‘good’ science – to critique the substance of the paper; they focused solely on attempting to discredit an established EBHC organisation and its journal. Such a response may explain the origins the postmodernist suspicion of science as, in Foucauldian terms, a ‘regime of truth’ in that these scientific commentators appear to be asserting that they know the source of ‘good’ scientific critique (and therefore, are privy to what is the truth) – and, because they are not aware of the source, it is unworthy of serious critique.”

    Goodness gracious me.

  14. Evil Kao Chiu said,

    December 12, 2006 at 9:45 am

    “Although this flies in the face of radical postmodernists who are cynical about all forms of scientific endeavour, many postmodern scholars concede that the delivery of complex care to sick people – or the promotion of health in a population – must take heed of empirical evidence.”

    Which I think says it all – ‘when it matters, best you don’t listen to us – ‘cos we’re talking out of our arses and we know it.’

  15. Tom P said,

    December 12, 2006 at 9:52 am

    Yes, I love how they try to claim the people pointing out how they can’t find the journal are making an ad hominem attack, and are refusing to engage in the substance of the paper and the context it appears in. It doesn’t seem to have crossed their minds that it’s hard to engage with the substance and context of a paper when you can’t even find the bloody thing.

  16. DrB said,

    December 12, 2006 at 10:24 am

    An attack on the journal? If I had a quid for every time I read a paper and thought “What were the editors/reviewers thinking?!” I could retire early.

    Given the level and nature of some bashing my own papers have got from non-acaemic bloggers, I think the discussion that took place about this paper on BS was wonderfully insightful and intelligent.

    (And I’m anonymous because that way I can talk in general terms about my students online and not have to worry that they’ll find it and take it personally…)

  17. Dr Aust said,

    December 12, 2006 at 10:29 am

    Note that in their response to the critical responses – most of which are not taking a line that different from the blog, no matter what Alan Pearson says – Dave Holmes et al. choose to kick off with a quote from French po-mo uber-pseud Jean Baudrillard.

    “Intellectual Impostures”, anyone?

    ‘Nuff said.

  18. superburger said,

    December 12, 2006 at 10:44 am

    “The nature of ‘truth’ is a recurring concern to postmodernists, who generally purport that there are no truths but multiple realities and that understandings of the human condition are dynamic and diverse. The notion that no, one view, theory or understanding should be privileged over another (or that no discourse should be silenced) is a tenet of postmodernist critique and analysis”

    And there’s the problem with applying po-mo to science.

    There are universal truths within science. If you mix acid + base you get salt + water. resultant force is proportional to mass . acceleration. Water will move across a permeable membrane until concentrations are equal – and so on through the gcse science syllabus.

    There cannot be a field of ‘serious’ science where blog posts are included in academic articles.

    Who’s to say that me ‘n’ Dr Aust weren’t plants by Pearson to let him write his piece, further revealing his genius?

  19. Ben Goldacre said,

    December 12, 2006 at 11:23 am

    I particularly enjoy the bit where he talks about critics being ignorant of the context, whilst responding to blog comments… in an academic article.

    seriously, watch out, they’re probably organising a conference about us as we speak. especially you, Dr Aust. you’re definitely their favourite.

  20. simongates said,

    December 12, 2006 at 11:27 am

    I can’t describe how proud I am to be quoted in such a paper. I just wish I’d been more careful to conceal my identity properly. Should I worry about suspicious packages in the post or lynch mobs of angry postmodernists?

    I should certainly get on and write the letter that I never got around to last time, in the hope of prolonging the fun…

  21. bootboy said,

    December 12, 2006 at 11:56 am

    “There are universal truths within science”

    Nope, there are theories that have vast quantities of experimental evidence behind them and no known observed phenomena which contradict them. The whole point of science is that you don’t care about universal truths, you just care about coming up with better ways of explaining the evidence.

  22. -K- said,

    December 12, 2006 at 12:46 pm

    “None of the contributors to the site revealed their names or contact addresses.”

    Yes, it’s the height of rudeness not to give your full name and address after all your postings on internet message boards.

    Yours faithfully,

    K
    1A The Internet
    Some Computers
    The World

  23. bawbag said,

    December 12, 2006 at 1:05 pm

    I cant beleive they have actually wrote a piece replying to blog comments.

    I wish I had commented on the original article. It’s childish but I would have liked to have seen them write Bawbag in an academic article.

  24. Martin said,

    December 12, 2006 at 1:21 pm

    OMG, reading through all that was hard work, and I’m not sure that I understood more than half of it.

    What is it with all of the attacks on double-blind randomised controlled trials and evidence-based knowledge? DBRC trials are the standard method of evaluating the effectiveness of, well, pretty much anything (new medicines, speaker cables, etc). They are the standard method because they have been proven to work.

    When homeopathic practitioners (or Allen Carr, for that matter) refuse to subject their methods to DBRC trials because “they don’t/can’t work for their treatments”, they don’t suggest alternatives which could be used. I’m willing to accept empirical evidence, but not anecdotal. I’d even believe what TAPL says, if she had evidence to back up her arguments.

    But the post-modernist nadgers above actually states “The notion that no, one view, theory or understanding should be privileged over another (or that no discourse should be silenced) is a tenet of postmodernist critique and analysis.” (Pearson does indicate that the original article isn’t from this “radical” position.) But doesn’t the above view indicate that the theory of evolution and intelligent design should be given equal weight? If this is true, then should the Great Green Arkleseizure Theory also be taught in our schools? (My God, I sound like Disgusted from Tunbridge Wells!)

    Science is generally OK about attacks on ‘sacred cows’; without critical thinking science wouldn’t have moved on since Galileo. But science does require the attack to be based on sound evidence. I could refute all of Stephen Hawking’s work (I have at least read his book), but without any proof I’d be (rightly) ignored.

    If the post-modernists, homeopaths, snake-oil pedlars, speaker cable manufacturers, etc, want to be taken seriously in a scientific debate, then they have to play by the scientists’ rules – just as scientists have to play by the media’s rules if they want their scientific breakthrough to be conveyed to the masses.

    Rant off – well done Ben on your excellent column and website and keep up the good work.

  25. superburger said,

    December 12, 2006 at 1:32 pm

    ““There are universal truths within science””

    hmm, i do think there are a few things which are universally true.

    Then again, I agree that the aim of science isn’t always truth, it’s just new and better hypotheses and explainations for observables.

  26. ayupmeduck said,

    December 12, 2006 at 1:44 pm

    These people simply have too much time on their hands.

  27. three tigers said,

    December 12, 2006 at 1:45 pm

    re #10 Yes it does. A quick google search reveals www.health.adelaide.edu.au/nursing/research/staff/alanpearson.html

    And the paper in question is listed.

  28. three tigers said,

    December 12, 2006 at 1:59 pm

    After a second look the paper is not listed, it’s another one from the same journal.

  29. ceec said,

    December 12, 2006 at 3:51 pm

    Hey! They quote me! How exciting! They seem to object to my noting (correctly) that the journal wasn’t listed on normal academic databases. Having conducted systematic reviews and generally having read a lot of academic papers, I’ve found that perceived journal quality (as indicated e.g. by its being held in university libraries, cited by articles in other journals, etc.) is a good indicator of the quality of the individual articles within those journals. There are bad articles in good journals, but there are rarely, if ever, good articles in bad journals.

    Simply tackling a weighty topic is not enough – you do actually need to do it well. I read the original article and as I recall it was too full of misunderstandings about EBM and Cochrane to be a credible critique, whatever the value of the basic (unoriginal) ideas about medicine, power etc.

  30. Gleamhound said,

    December 12, 2006 at 4:41 pm

    #29 “There are bad articles in good journals, but there are rarely, if ever, good articles in bad journals. ”

    Agreed. The tone and style of this piece is not exactly that found in Nature/Science/Proc. R. Soc even on their worst days.

  31. RS said,

    December 12, 2006 at 5:20 pm

    By treating blog comments the same way they’d respond to academic criticism, i.e. failing to ‘privilege’ academic discourse over other forms, they are just taking their postmodernism to its logical conclusion – admirable consistency really, the morons.

  32. Bob O'H said,

    December 12, 2006 at 5:23 pm

    Anyone up for submitting a response? And using your web personas in the list of authors.

    Bob

  33. ceec said,

    December 12, 2006 at 5:33 pm

    And anyway, the discussion about the merits of the journal was in the context of defending the value of this type of work in general (there were a lot of rather silly “all sociology is guff” type posts) i.e. that this article shouldn’t be taken as the best that sociology has to offer.

    The new article doesn’t really seem to engage with that aspect of the debate. Mind you, I am now more than au fait with the original authors’ views on lynching. Thank goodness someone is against it!

  34. RS said,

    December 12, 2006 at 5:33 pm

    It is brilliant that doctor and part-time journalist Ben Goldacre plus his assorted blog commenters represent a sinister (fascist even) “attempt to silence dissenting views”. How dare some randoms on the internet fail to “critique the paper in a scholarly fashion”?! i hope you realise your “ill-informed, reactionary responses…make little contribution to the ongoing development of evidence to improve global health”!

  35. RS said,

    December 12, 2006 at 5:53 pm

    Oh dear god, just flicked through that article again. The onus is really on them to explain why anyone should even bother engaging with such palpable drivel! I love the way that when you breakdown what people like this have to say into simple language it just reads “science bad”.

    “Ello sir, looks like you’re having a heart attack, I can give you thrombolysis which has been shown to markedly improve the chances of survival, or I can sit down and consider your ‘qualitative and vital being-in-the-world’ instead, what’s it to be?”

    I don’t want to sound snotty, but there is definitely a certain kind of nursing academic that produces this sort of stuff.

  36. arthurtree said,

    December 12, 2006 at 6:10 pm

    “I don’t want to sound snotty, but there is definitely a certain kind of nursing academic that produces this sort of stuff.”

    I wouldnt say it was snotty RS, just bang on.

  37. jessina said,

    December 12, 2006 at 7:04 pm

    When I did work experience at nature they had a place for papers like this: a box labelled ‘Cranks’.

    I don’t know about you but I’d rather have medicine based on ‘evidence’ than on…whatever it is that they’re trying to suggest is an alternative. My brain was turned to mush by their pretension.

  38. oneoffmanmental said,

    December 12, 2006 at 7:59 pm

    I picked up Bruno Latour’s 2004 book, The Politics of Nature.

    I have to say it’s bloody amazing. He single handedly criticises both the positions of “science” and relativists with equal rigour.

  39. oneoffmanmental said,

    December 12, 2006 at 8:25 pm

    Ok, so they quote blog comments to critique LAY opinion. Nothing wrong with that. It’s a bit like saying all academic papers can’t have quotes from normal people on the street. What constitutes scientific quoting anyway? Taking a blind random sample of text, e.g.:

    “#

    ave to worry that they’ll find it and take it personally…)
    #
    Dr Aust said,

    December 12, 2006 at 10:29 am ”

    Was that meaningful?

    It’s especially odd since the paper is still criticising Holmes’ study.

    And yes, a lot of you did bring JBI’s journal into disrepute.

  40. RS said,

    December 12, 2006 at 9:05 pm

    “Although it is not surprising that the language used by the authors generated media coverage, the response by some ’scientists’ was unexpected…….Ben Goldacre, writing in the British Guardian newspaper” and some blog commenters – clearly the very science establishment itself!

    “From the postings that appeared on August 20 2006, it was clear that the contributors had no knowledge of the JBI or the journal; that very few had attempted to locate the journal issue; and that this lack of detail did not weigh in their responses as information worth pursuing. As a result, none were aware that an editorial and a response to the paper – both refuting the conclusions drawn in the paper – were published alongside it. None of the contributors to the site revealed their names or contact addresses.”

    Nice piece of rhetoric here, note that it is only true if you only focus on the date of August the 20th, which is clearly not the point they’re trying to make. Ugly ugly piece of sleight of hand. Bad bad boys:

    “Wiretrip said,
    August 19, 2006 at 11:46 am
    Alright, I accept that this particular paper is based upon a misunderstanding, but the so is your article (and the subsequent comments).”

    “Dr Aust said,
    August 21, 2006 at 3:53 pm
    On navigating to the relevant issue of the journal I notice there is an editorial about the Holmes et al. paper (titled, presumably in the spirit of editorial puckishness “The bankruptcy of evidence- based practice?” – note the question mark) and also a response to the paper. The latter is a critique – at least I hope it is – since it is titled “Never mind the evidence -feel the width” (p 187-8).
    Anyone with free full text access (or a large bank account and a crusading nature) care to dig out the full text of these?”

    The JBI appears, at least from a look at their website
    www.joannabriggs.edu.au/about/home.php
    to be trying to look a bit like the Cochrane Collaboration, and there is a “Cochrane Qualitative Methods Group” which is part of the JBI:
    www.joannabriggs.edu.au/cqrmg/about.html
    Anyone in the know (Australian academic readers?) care to fill us in on the JBI?”

    “katem said,
    August 23, 2006 at 9:17 am
    Dr Aust,
    UCD has free access to the journal. Articles as follows (in 2 posts):
    Int J Evid Based Healthc 2006; 4: 161
    Editorial…”

    So their argument that ‘scientists’ rallied around to cast nasty ad hominem arguments against the paper, ignoring the contrary papers in the issue, in order to suppress dissent from their fascistic enterprise actually shows an article by Ben (doctor, journalist) plus a small number of blog comments (from various ananymous individuals on the internet) over a strictly limited time period. And they wrote a paper on this!

    (I think I’ve used my allocation of exclamation marks for the month)

  41. ceec said,

    December 12, 2006 at 10:06 pm

    Good work RS, but I think you may be forgetting about the multiple realities which allow the blog entries before and after 20th August to disappear every now and again in little puffs of totalitarianism.

  42. j said,

    December 12, 2006 at 11:16 pm

    “By treating blog comments the same way they’d respond to academic criticism, i.e. failing to ‘privilege’ academic discourse over other forms, they are just taking their postmodernism to its logical conclusion – admirable consistency really, the morons.”

    Nah, if the authors did that they would have been almost consistant. However, after complaining that EBM is exclusionary in their first article, they then moan that their critics (when they’re writing on blogs) aren’t sufficiently ‘scholarly’.

    Fascists.

  43. micromegas said,

    December 12, 2006 at 11:43 pm

    “Postmodernism asks the questions who is speaking; what is being said; what is not being said; and whose interests are being served?”

    The wonderful thing about postmodernism is that it can be so self-reflexive. Applying the above set of questions to this postmodern critique gives us the respective answers: a crowd of people with too much time on their hands; a load of nonsensical crap; anything remotely coherent; a crowd of people with too much time on their hands.

    It really gets my goat when people (like that Aussie TV producer with the PhD in Philosophy) start using Kuhn and Feyerabend to justify attacks on science that appear designed solely to further their own profile (be it in academia, journalism, pseudo-science or wherever).

    If the potential implications of these charlatans being taken seriously were not so grave, the whole thing would be absolutely hilarious. My favourite has to be the French feminist/cultural theorist Luce Irigaray who has claimed that the reason science has a lesser understanding of fluid compared to solid mechanics is because the scientific establishment is chauvinist and that solidity is a masculine characteristic (whereas fluidity is a much more feminine concept).

    The scary thing is that this sort of writing is so easy to duplicate. Not only was Sokal able to write a complete parody which was taken seriously at the highest level (www.badscience.net/?p=39), but there are actually algorithms out there that will write whole postmodern articles for you: www.elsewhere.org/pomo.

  44. oneoffmanmental said,

    December 13, 2006 at 5:30 am

    I think we need to revise Godwin’s law.

    As an online discussion about the sciences grows longer, the probability of a comparison involving Sokal approaches one.

  45. NelsonGabriel said,

    December 13, 2006 at 11:11 am

    There’s a way we can maximise the number of us who are cited next time around, and which will make at least as much sense: one word at a time each.

    I’ll start:
    Dear

    (Thanks to the teams, Samantha and myself and everyone at I’m Sorry I
    Haven’t A Clue: I think the game above is called Word For Word.)

  46. Big_Les said,

    December 13, 2006 at 11:40 am

    Not really the same thing. It just goes to show what an impact his hoax has had.

  47. Big_Les said,

    December 13, 2006 at 11:42 am

    ^sorry, that was a response to p44 – should have refreshed my browser.

  48. simongates said,

    December 13, 2006 at 11:50 am

    #45 No, it’s Cheddar Gorge

  49. David Mingay said,

    December 13, 2006 at 1:24 pm

    No reason for us not to play Cheddar Gorge, since they’re playing Uxbridge English Dictionary.

  50. Dr Aust said,

    December 13, 2006 at 9:15 pm

    Another nice anecdore to emphasize why calling all believers in scientific evidence “microfascists” is so glibly offensive (posted this on the forum as well, so apologies for the double-posting)

    Prof Sir Bernard Katz FRS, Jewish refugee from Nazism, Nobel Laureate and one of the greatest scientists of the 20th century, was once asked by his son David what had been his greatest achievement.

    He replied that his scientific work, satisfying as it had been, and a marvellous chance to learn, had been a bonus.

    “The most important thing he’d done, along with countless others, was to have played a small part in defeating 20th century fascism for a time. He could imagine nothing more essential than that.”

    www.physiol.ucl.ac.uk/Bernard_Katz/davidkatz.htm

    Was pondering using this anecdote in a ripose to the Int J Evidence based etc. Trouble is, I can’t decide between a “considered scholarly response” from my vaguely serious persona, or a fireball of screaming invective from my playfully postmodernist blog avatar.

  51. Neil Desperandum said,

    December 13, 2006 at 9:43 pm

    There’s another quote from that Katz memorial link that might help.

    A.V Hill about an exchange with Nazi ex-scientist Johannes Stark: “Laughter is the best detergent for nonsense.”

    So let’s just continue to take the piss.

  52. Neil Desperandum said,

    December 13, 2006 at 9:44 pm

    Cheddar Gorge hasn’t got very far.

    Dear big

  53. potentilla said,

    December 13, 2006 at 9:55 pm

    Come on guys, can’t you see what is going on here? The scholarly paper response, in the bit about you, is mostly complaining that you are dissing the journal. That’s because the guy who wrote the article publishes in it: here he is; and is generally involved with the Joanna Briggs Institute. Here’s the journal.

    Deconstructed, his article says “I am a respectable scientific academic publishing in respectable scientific journals and you’re all very mean to doubt it”.

  54. potentilla said,

    December 13, 2006 at 9:57 pm

    Let’s try that again (no preview funtion?). Here he is.

  55. Ben Goldacre said,

    December 13, 2006 at 10:13 pm

    heh, good fun commentary from the wonderful ophelia benson of the wonderful butterflies and wheels

    www.butterfliesandwheels.com/notesarchive.php?id=1709

  56. Dr Aust said,

    December 13, 2006 at 10:14 pm

    Neil quoted:

    “A.V Hill about an exchange with Nazi ex-scientist Johannes Stark: “Laughter is the best detergent for nonsense.””

    Yes, I was going to use that one too, Neil.

    Spot on about taking the piss. A “serious scholarly critique” is an appropriate response to a serious article. The appropriate response to a load of bollocks is a good blog-pasting. The editor’s self-justification was actually rather nervy when he was trying to explain why it had been courageous (?) to publish the full version of the Holmes paper.

    Speaking as an editor, even if he wanted to “inaugurate the debate” he should have started by telling them to come back when they had written a version which stated the essential ideas clearly and without exaggeration, untruths and polemic – in about 20% as many words.

    BTW, if anyone is interested in reading more about Bernard Katz and his life a good intro is David Colquhoun’s appreciation at:

    www.physoc.org/publications/pn/issuepdf/52/34.pdf

  57. Melissa said,

    December 14, 2006 at 4:50 am

    Is it even possible to write postmodernist deconstructions without using unnecessarily obfuscatory linguistic shenanigans?

    I suppose that if you distill away their verbiage, all they’re left with is, “Nah-nah, we’re right and you’re wrong! Down with everything! Fascists!!!” It’s like listening to Rick from “The Young Ones.”

  58. JQH said,

    December 14, 2006 at 8:16 am

    Has it occurred to anybody that the rest of academia has ignored their obscurantist rant? That’s the only possible reason why they have responded to “unscholarly” bloggers. They certainly don’t like criticism. Melissa’s comparison with “The Young Ones” is spot on. They’re just bouncing up and down shouting “EVERYBODY SHUT UP AND LISTEN TO ME!”

  59. simongates said,

    December 14, 2006 at 9:14 am

    re #58. Good point. I work in evidence based health care and I can honestly say that I haven’t heard any reaction at all to this article from the wider academic community. There has been some reaction from people I know because I’ve sent it to them so they can have a good laugh. They have universally had the same response to it: (a) what on earth are they on about? (b) are they serious? (c) this was in a scientific journal???

  60. Laurence said,

    December 14, 2006 at 11:53 am

    I think the editorial of the journal and Alan Pearson can be excused for feeling a little peeved at some of the original comments – which are quoted in this subsequent article. There was a lot of bluster and aspersions were thrown at the journal (which certainly appears in Sheffield University’s library) without any real sense of perspective. Perhaps there’s some sense of insecurity behind the sheer volume of some of the comments?

    I’m as concerned for good sense in research as anyone, and would certainly oppose any attempt to use qualitative/quantitative positivist/constructionist arguments as a back door through which to sneak in abusive and nonsensical quack healthcare notions. But some of the more excitable comments about “postmodernism” (whatever that might mean in each of our personal definitions) seem to be going overboard and forgetting that not everything about human beings can be understood, explored, and explained, in terms of numbers and quasi-experimental methods.

    Calling people who insist on blind trials fascists does no good to the sum of human wisdom. But then, nor does immediate dismissal of any other methodology or paradigm in any subject. But then I suppose, this is the internet, and it’s the place for letting off steam! We all get a little braver and more excitable in the virtual world.

  61. ceec said,

    December 14, 2006 at 12:14 pm

    #60 I agree – the problem with the new article is that it quotes the blogs completely out of context. I went back to the original thread and had a look to see how many posts were dismissive of postmodernism etc. and how many were broadly supportive. Anyone with some time on their hands can count them, but there were quite a lot of supportive posts (not supporting the paper, necessarily, but noting the value of using a post-modernist approach). The discussion of the quality of the journal was an adjunct to that broader discussion, not the focus of it. In fact, around the remarks quoted in the new paper, there were others which were contradictory which were omitted. The author simply cherry-picked quotes out of context to suit the argument of the paper. While this is common practice for journalists, it’s rather frowned upon in academic circles.

    To claim, as the article does, that this blog is somehow part of a wider tendency to disallow anything other than establishment voices from comment on evidence-based medicine is not even based on the content of the blog itself, and manages to do exactly what it is complaining about i.e. silencing contradictory voices.

    The editor obviously thinks it’s a good idea to print “other perspectives” in the journal – and this is laudable. The problem is that he/she was unable to identify that this was a very crap article on the subject full of error and hyperbole. It would be interesting to know who it was sent to for peer review (if it was peer-reviewed).

  62. superburger said,

    December 14, 2006 at 12:59 pm

    Laurence,

    A journal, claiming to be serious peer reviewed healthcare journal, publishes an article which describes the Cohchrane library as inter alia, fascist. It also contains inaccuracies and fallacies which should not have escaped competent non-ideological editors (see, for example, the original badscience column)

    “The classification of scientific evidence as proposed by the Cochrane Group [sic]… 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”

    Seriously?

    The badscience column in the Guardian got a lot of people talking about po-mo interpretations of the world. Some of the comments were insightful, some were a bit ‘lets slag off all sociology.’ This is the nature of bulletin boards (sorry, we call them ‘blogs’ these days….)

    “But some of the more excitable comments about “postmodernism” (whatever that might mean in each of our personal definitions) seem to be going overboard and forgetting that not everything about human beings can be understood, explored, and explained, in terms of numbers and quasi-experimental methods”

    I’m not sure anyone would say that all human life can be understood by numbers or experiment. There are significant difficulties in trying to apply a po-mo appraoch to discussing science. Namely that in science there exist observable truths (if you jump out of a window you will fall towards the centre of the earth at ca. 9.8 m/s/s/) whereas, as I understand it, po-mo takes the position that there are not absolute truths. This is my simplistic view – then again, I am not attempting to write a ‘scholarly’ crtique of the topic.

    Pearson then took these blog comments onboard, and managed to publish, in an academic journal, people’s comments on a blog!! That is absurd. For a start, cherry-picking your data to prove a point is unnacceptable in science or the social sciences, by any definition.

    If he wanted to use badscience blog posts as a representative sample of the scientific communities opinion (a flawed idea, in itself, I believe) then some sort of genuine data analysis would be needed.

    How did he know that all the people he quotes are not the same person posting from multiple accounts?

    Can you think of any serious academic article that cites selected blog posts as sources?

    You’re exactly right that people let of steam on the internet, so Pearson criticising people for not acting in a ‘scholarly’ manner online is absurd!

    I’m glad my alma mater carries the journal though……..

  63. JQH said,

    December 14, 2006 at 1:10 pm

    Laurence, none of the comments were as long as the original article, so if length is a failing what does that say about said aricle? Most of the criticisms were levelled at the deliberately obscure language used by the writers.

    Nor were any bloggers dismissing any other methodologys or paradigms put forward, because the article did not put any forward. Don’t you think doctors can “feel a little peeved” at being called fascists because they insist on evidence that treatment works before generally prescribing it?

  64. RS said,

    December 14, 2006 at 1:46 pm

    “Don’t you think doctors can “feel a little peeved” at being called fascists because they insist on evidence that treatment works before generally prescribing it?”

    That’s the point really, no one has written (let alone published) a ‘scholarly response’ to the article because that is all it actually says, once you’ve stripped away the unnecessary verbiage. We haven’t responded because we don’t take its challenge seriously, it is self-evidently bollocks, and rather pompous bollocks at that.

  65. bootboy said,

    December 14, 2006 at 2:03 pm

    “Namely that in science there exist observable truths (if you jump out of a window you will fall towards the centre of the earth at ca. 9.8 m/s/s/) whereas, as I understand it, po-mo takes the position that there are not absolute truths.”

    This is the problem. If you try to argue in favour of absolute truths, post-modernism wins. They can point to the ‘observer function’, the ‘induction problem’ and you will get bogged down in the impossible attempt to identify a pure objectivity. Before you know it, you’re back with the 18th century philosophers trying to prove that objective reality exists.

    Scientists shouldn’t go there. We should accept the fact that there are no absolute truths as a trivial observation, while also recognising the fact that there are some things that are undoubtedly closer to truth than other things. We just try to get as close as we can, using the simple scientific method.

    Post-modernism, stripped of the verbiage basically reduces to the hypothesis that “all observations are coloured by the observer’s view”. Some of the bigger bullshitters in the game extend this to claim that “all observations are equally coloured by the observer’s view” which is patent nonsense, and its corollary “all views are equally important”, which is similarly nonsense. However, the idea that it is worthwhile considering all points of view and not attempting to consider one particular point of view as authoritative is useful in itself. Some of the non-bullshit filled areas of post-modernist enquiry are quite useful in that they seek to discover alternative views which have not traditionally been considered significant – women’s voices in history for example. Unfortunately, the fundamental confusion that is mentioned above added to the characteristically showy and elitist language used, means that the whole field is a bullshitter’s delight. Still, just because that is so, it doesn’t make it big or clever to write off everything about it without examining it properly.

  66. tjb said,

    December 14, 2006 at 2:49 pm

    Chip Morningstar has what I think of as a pretty fair and lucid introduction to (at least one kind of) pomo at:

    www.fudco.com/chip/deconstr.html

    “The Pseudo Politically Correct term that I would use to describe the mind set of postmodernism is ‘epistemologically challenged': a constitutional inability to adopt a reasonable way to tell the good stuff from the bad stuff.”

    might be the relevant bit here.

  67. Melissa said,

    December 14, 2006 at 2:58 pm

    Just to be clear, I’m not trying to slag all pomo approaches to everything. I agree it can be useful in the field of sociology. BUT it is utterly ridiculous when applied to sciences. Yes, it’s impossible to be completely free of observer bias– that is the whole *purpose* of the double-blind trial! For postmodernists to then slag it as fascism… well, at that point they might as well don their yellow overalls and dance to their Cliff Richard song.

  68. warumich said,

    December 14, 2006 at 4:10 pm

    Anyway, postmodernism is, like, soooo mid to late eighties

    soc.sagepub.com/cgi/content/abstract/40/3/529

    Sociology, Vol. 40, No. 3, 529-547 (2006)
    Steve Matthewman and Douglas Hoey
    ‘What Happened to Postmodernism?’

    … dudes

  69. Laurence said,

    December 14, 2006 at 5:24 pm

    In answer to #62

    Oh I’m not doubting that this was an error of judgement, in many ways. But I’ve found articles in every serious journal of my subject interests (landscape, horticulture, and landscape planning, for what it’s worth) that I’d say were badly written, ill thought out, and should not have been included. As it is, (a) I doubt it’s fair to discuss a journal’s reputability on the basis of isolated occurrences (b) I’m rather convinced by the journal concerned printing repudiations of the article – after all these are mounting issues in public debate, and so should at least be presented by a supporter before they are then given a comeback by a sound critique.

    I admire Ben’s newspaper column hugely – it’s funny and informative, and contains a heck of a lot of good sense. I was more trying to suggest that there’s summit about the nature of blogs that tends to get us a bit more excitable and looser in our talk – and that, in this virtual context, it’s easy to forget some critical faculties, and that some people appeared to be jumping on some gleeful bandwagon (whether what they are against can be called postmodernism or constructivism or whatever). After all, science covers a very broad range – though a lot of Ben’s original concerns are medical related. This is more a matter for the board, as a whole span of months of comment.

    A very real concern of yourself and “ceec”, which I share, is that this ‘fascist‘article appears to be a case of people assuming that using qualitative methodology and non-positivistic (whether that be deconstructionist or realist or whatever) paradigms allows us to say what we like. As you’ve pointed out, there are real concerns with validity, analysis, and generalisability that come out of what was written in the article (and the subsequent one that quotes people from this board). On all counts it aint too sound. I suspect this was the wrong place to publish it, reading more like a newspaper or commentary piece – perhaps they should set up some counterpoint to badscience!

  70. Laurence said,

    December 14, 2006 at 5:26 pm

    As an appendix, I’d say that the writers of the ‘fascist’ article should be a heck of a lot more worried about how our research – whatever our fields of concern – relate to, and are affected by, political power, media power, economic power, etc, rather than each other (though we should continually reflect upon who are the ‘gatekeepers’ in academic and scientific knowledge). This is where the real abuse of truth can and does readily occur – as witnessed, in an in extreme form, by the contemporary USA:

    news.bbc.co.uk/1/hi/sci/tech/6178213.stm

  71. jackpt said,

    December 14, 2006 at 5:41 pm

    Laurence, my problem is that being published in a journal (rightly or wrongly) raises the status of the work. Blog comments, indeed blog entries, can be as much off the wrist as that fella from Silence of the Lambs that flicks jizz at agent Starling. That’s a given. A journal that claims to have a certain limited range of subject matters publishing something so clearly in opposition to its limited range of subject matters is at best bogus. It’s not like they can show that there was any particular benefit in publishing it, or that it’s original. If people in evidence based medicine want to dabble in (the worst of 20th Century) philosophy there are half a dozen other journals they can subscribe to. Effectively by publishing the original article they were wiping up jizz and giving the spanker a platform.

  72. Ben Goldacre said,

    December 14, 2006 at 5:43 pm

    “Effectively by publishing the original article they were wiping up jizz and giving the spanker a platform.”

    you are just too obviously trying to get quoted in their next academic article.

  73. jackpt said,

    December 14, 2006 at 5:48 pm

    Yes, the thought did cross my mind. But isn’t it all equally valid? What is wrong with multiple sides to the debate? ;-)

  74. RS said,

    December 14, 2006 at 6:56 pm

    Whilst I’m not a raving postmodernist, you have to remember that the editors of journals have interests that aren’t necessarily completely in line with ‘the interests of science’ (or however you want to put it). So they will often stick in stuff that they think will ruffle a few feathers to raise the profile of their journal – I’m thinking of that shit animal research is useless article in the BMJ, or even the Iraq death toll study in the Lancet (not necessarily shit, but definitely there to provoke a response).

    I have to share my absolute favourite paper of all time:
    www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15325026&query_hl=8&itool=pubmed_docsum
    “Is there an association between the use of heeled footwear and schizophrenia?”

    Which I’ve always assumed was an amusing spoof, but then that was how I felt about the Holmes article until relatively recently.

  75. Dr Aust said,

    December 14, 2006 at 8:24 pm

    For published medical curiosities, as well as startling examples of human weirdness, journals of Forensic Pathology are hard to beat. For instance:

    www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=9662120

    – and there are more like this. You couldn’t make it up…

  76. Laurence said,

    December 15, 2006 at 9:24 am

    “A journal that claims to have a certain limited range of subject matters publishing something so clearly in opposition to its limited range of subject matters is at best bogus.”

    Not if they want to discount the thesis of the article, it isn’t. After all, here’s a journal that’s part of the so-called ‘fascist’ community allowing the very charges to be made in public – then carefully examining them in public. It’s a pretty good way of nullifying the claims, if that’s what you’re after.

  77. superburger said,

    December 15, 2006 at 1:24 pm

    Lively debate about controversial topics in academic journals is a wonderful thing.

    But can it honestly be appropriate to publish selected blog comments in a ‘scholarly’ article,,,,

  78. jackpt said,

    December 15, 2006 at 6:20 pm

    Laurence, fair enough, good point. But sometimes merely engaging with people raises their status. Sure, I think allowing the charges to be made in public is generally a good thing, but not when the position is so obviously absurd. Deconstructivism, post modernism, and the tangential off-shoot are mostly unrelated to science (unlike much 20th century philosophy). I can imagine many of the more relevant philosophers turning in their graves at what’s going on with post modernism and it’s inbred children.

    I read a wonderful piss take of that sort of thing by Harry Frankfurt, called On Bullshit, published by Princeton University Press, of which the only bit my sleep deprived brain remembers right now is “And insofar as this is the case, sincerity itself is bullshit” which I think is at the end. The first chapter is available here. Great stocking filler. If you’re into that sort of thing.

  79. Andrew Clegg said,

    December 16, 2006 at 4:22 pm

    I can’t help feeling that the fatal flaw with post-modernism is that the general policy of giving equal footing to dissenting views, and refusing to treat any opinion as less valid than any other, actually — when you think it through — supports unpleasant lunatic-fringe ideologies like fascism.

    If telling right from wrong is itself bad-and-wrong, how can you dismiss fascists as evil bastards?

    Andrew.

  80. Dr Aust said,

    December 16, 2006 at 9:00 pm

    Re #79

    Quite so, Andrew. This was implicit in Alan Sokal’s opposition to po-mo which led him to dream up the “Social Text” hoax/parody – see:

    www.physics.nyu.edu/faculty/sokal/afterword_v1a/afterword_v1a_singlefile.html

    Francis Wheen also covers this in “Mumbo-Jumbo” – for instance, if all views are equally valid, what does po-mo say about the Holocaust and other documented examples of genocide and mass extermination? They were “texts”? And the deniers, whether of the Holocaust or apologists for Stalin or Mao? Do they have an equally valid “narrative”? A better example of the moral and intellectual bankruptcy of po-mo would be hard to find.

  81. Laurence said,

    December 18, 2006 at 1:51 pm

    76,

    Oh I agree that this is an abuse of post modern and deconstructionist approaches – which, for what it’s worth, have allowed so much potential for picking apart the shams of the powerful. (Where I have issues, personally, is where people try to go on and deny the reality of a material world beyond ourselves – which is a supremely arrogant and anthropocentric mistake). This is an inappropriate use of such approaches. I just happen to think it’s better to deal with it in public, when the very charge is that there is deliberate stifling of debate. But then, as columns on this weblogg have shown, time and again, the public and media are easily bamboozled and carried away.

    That book sounds grande – I’ll have to take a peek.

  82. Laurence said,

    December 18, 2006 at 1:56 pm

    Oops – that was meant to be in answer to 78 rather than myself. That might be seen as arrogant.

    “But can it honestly be appropriate to publish selected blog comments in a ’scholarly’ article,,,,”

    It depends what they’re being used for. If they are being quoted in the same way as one would with a literature review or selection of a theoretical position on which to based interpretation of results, then it’d be potentially both inappropriate and dangerous. The nature of the weblogg beast is too unstable and often uninformed. But. If they’re being quoted as a sample of information (results) – a la interview transcripts, diaries, etc – which are going to be analysed, and if they are used carefully, then there’s nothing wrong with using them in academic research per say. If the research is about what people think/perceive of something.

  83. bootboy said,

    December 18, 2006 at 5:42 pm

    “But can it honestly be appropriate to publish selected blog comments in a ’scholarly’ article,,,,”

    More to the point, why not publish the response as a comment, surely the fairest and most appropriate choice. I mean, it’s really a bit unfair to carry out your side of the argument in a forum where most of the participants are excluded from when there is a level-playing field available where everybody can have their say.

  84. Delster said,

    December 19, 2006 at 1:51 pm

    Seeing as Science, such as chemistry & physics anyway, is basically about trying to explain the world around us how are scientists supposed to develop theories & advance knowledge with anything but evidence based observations?

    There is no other way but to have a poke at the world and watch how it reacts.

    Having said that, what has to be done is to poke part of the world in a certain precise way and watch for a reaction to that poke.

    How you tell if the poke is what’s caused the effect is by having another part of the world, which is simillar in all other ways, remain unpoked.

    And, to ensure the scientist in question does not bring personal bias into it, you get somebody else to do the poking so the scientist just watches for the reaction to the poke or non poke.

    Oh hang on… that looks like a blinded control trial to me…. who’d have thought it?

    If any postmodernists wish to explain another method for advancing science then please let me know…. i’ll even give my real name and address if they want to publish this as serious scientific comment.

    Oh and while i’m avoiding work on here… Evidence according to my big book of words can also be said as Proof, Confirmation, Facts, Data, Substantiation, Verification, Support & Indication.

    The way scientists use it is the last two. Support & Indication i.e. Evidence supports the theory or evidence indicates the theory is correct (or incorrect of course)

    As for Normalising evidence (think that was the one they criticised… should have taken notes with the length of those articals) That is just about taking lots and lots of pokes at the world and finding the average (or normal) response.

  85. atomic dog said,

    December 20, 2006 at 3:20 am

    Look, the article’s crap. And it’s probably useless trying to make this point on this kind of list, but just for the record “postmodern” is a pretty vague term. Most people who use it in a positive sense are poseurs; most people who use it negatively are slanging away at huge swathes of literature they haven’t read, as is usually true when someone brings up Sokal (_Social Text_, which he hoaxed, is not even a refereed journal).

    There *is* a minor tradition in French intellectual life of saying stupid things about science, most prominently Lyotard’s irresponsible 1979 _La Condition postmoderne: rapport sur le savoir_. But the broad, indiscriminate comments above about an entity called “postmodernism” are also silly in their own way. Bruno Latour, mentioned briefly above, is not an idiot. Foucault, who took science very seriously, was a lot smarter than most people who write “Foucauldian.”

  86. ceec said,

    December 20, 2006 at 5:33 pm

    Even leaving aside the problem of knowing who they are exactly, challenging “postmodernists” to explain things like gravity (or other stuff cited in this thread), is like asking physicists to explain symbolism, historians to explain chemical reactions, or biologists to explain pragmatics. Different disciplines, different areas of enquiry, different aims, different purpose.

    The idea that science advances on the basis of evidence (rather than, say, on the whim of funding agencies/journal editors/big pharma/US political interests), however, is a lovely thought which I will cling to for yuletide comfort.

  87. atomic dog said,

    December 20, 2006 at 9:14 pm

    Re Sokal (#44 is astute)

    Berube, M. 2006 “The Sokal Hoax for Beginners.” Pp. 15-34 in _Rhetorical Occasions: Essays on Humans and the Humanities_ UNC Press.

    Re “postmodern:”

    Anderson, Perry. 1998. _The origins of postmodernity_ Verso.

    Quick oversimplification: “postmodern” arises in the 70s as a label for a set of artistic styles, and as the banner under which Lyotard attacks “grands recits” (referenced in my last post). Lyotard seems to be the basis for what Anderson terms the “street-level relativism” that a lot of people associate with postmodernity, as evident in the thread above.

    Lyotard’s book fits the pattern of using poorly-understood snippets about quantum physics, nonlinearities, complex systems etc. to claim that reality is impossibly weird and systematic knowledge impossible. Scientists are right to mock this as well as opportunistic uses of Kuhn and Lakatos. Lyotard later admitted (there’s a fn in Anderson) that this was a bit of a con.

    What’s less thoroughly understood by the scientists I talk to is that Lyotard’s position was not, nor has it become, the hegemonic position of humanities and social sciences or even any large chunk of them. Instead Lyotard was, in this and subsequent writings, attacking the “grands recits” of Marxism, Sartrean humanism, Habermas’ communicative ideal, Freudianism, Structuralism, and whatnot.

    As developed by Fredric Jameson, “postmodernism” has been used *against* poststructuralism (whose most prominent representative is Foucault), which includes a great deal of work on race, gender, and sexuality.

    So:

    1. When I hear people using the term “postmodern” to include what postmodernism attacks, I know they don’t know what they’re talking about.

    2. All the scientists of my acquaintance have run into the “street-level relativism” Anderson refers to, whether from the ill-trained humanities grads or in silly articles like the one cited at the top of this thread. But some of them then conflate *any* critique of knowledge or the institutions in which knowledge is made with the stupidest critiques.

  88. Delster said,

    December 21, 2006 at 10:32 am

    ceec,

    science always progresses according to the evidence…. the key word there being progresses… the rest is flim flam wearing a mask

  89. raven23 said,

    December 29, 2006 at 3:41 pm

    As a philosophy grad….

    … no, really, you can stop blowing raspberries now, I AM a philosophy grad (well, 3rd class hons drama & philosophy to be precise, which I believe qualifies me to talk loudly in restaraunts and not much else)…

    … Can I just say how badly these guys misrepresent post-modernism as well as science? I can hear several folks I deeply respect from the philosophy world muttering “that’s so wrong, I can’t even dignify it with the word wrong. ‘wrong’ would imply that they had made a few errors that you could correct. This is beyond wrong”.

    I’m reminded of a friends opinion on “The Tao of Physics”: “This would be a great book if the author understood anything about quantum physics. Or Daoism.”

    It’s amazing that a movement that started partly as a reaction against irrational “priveliged narratives” has become a tool to privelige any narrative, so long as it’s irrational.