Archie Cochrane: “Fascist”

August 19th, 2006 by Ben Goldacre in bad science, heroes, postmodernist bollocks | 83 Comments »

Ben Goldacre
Saturday August 19, 2006
The Guardian

“Deconstructing the evidence-based discourse in health sciences: truth, power and fascism.” Even from looking at the title, you just know this academic paper, from the September edition of the International Journal of Evidence-based Healthcare, is going to be a corker. And it uses the word “fascist” (or elaborate derivatives) 28 times in 6 pages, which even Rik Mayall in the Young Ones might regard as over-egged.

I say!

Now obviously post modernist intellectuals are about a thousand times more intelligent than me – because I only know about science and computers – but I found this paper so confusing I thought it might be a spoof. After all, who could forget the great Sokal hoax, where a professor of physics at NYU submitted “Transgressing The Boundaries: Towards A Transformative Hermeneutics Of Quantum Physics”, a deliberately meaningless joke article purporting to undermine his own discipline, to Social Text, a leading journal in the field, and had it accepted and published, to universal delight?

But this is very real, very turgid, spectacularly offensive, and characteristically, completely misunderstands its target. Here’s what they put in the “objectives” section of their abstract: “The philosophical work of Deleuze and Guattari proves to be useful in showing how health sciences are colonised (territorialised) by an all-encompassing scientific research paradigm – that of post-positivism – but also and foremost in showing the process by which a dominant ideology comes to exclude alternative forms of knowledge, therefore acting as a fascist structure.”

Let me put my fascist cards on the table and point out right up front that these are not “objectives”. Although of course, academic woolliness goes with the territory. In case you haven’t heard of their quoted authority, the continental philosopher Felix Guattari, here is a quick quote from his other work which I think betrays an admirable clarity: “We can clearly see that there is no bi-univocal correspondence between linear signifying links or archi-writing, depending on the author, and this multireferential, multi-dimensional machinic catalysis.” Perhaps Gilles Deleuze is more your cup of tea: “In the first place, singularities-events correspond to heterogeneous series which are organized into a system which is neither stable nor unstable [Jesus], but rather ‘metastable’, endowed with a potential energy wherein the differences between series are distributed.”

These characters are being recruited to attack the notion of evidence based medicine, and the argument of this paper – bear in mind it’s not an easy read – seems to be that: evidence based medicine rejects anything that isnt a randomised control trial (which is untrue); the Cochrane Library, for some reason, is the chief architect of this project; and lastly, that this constitutes fascism, in some meaning of the word they enjoy (28 times).

Here’s a flavour. “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.” They bang on about Newspeak. At one point they seem to identify epidemiologists with George W Bush. And so on.

Now firstly, they are plain wrong about the Cochrane Library (which simply produces good reviews of published literature): it does not only use trial data, as they claim, and it is spectacularly ignorant of them to suggest otherwise.

But there is a more important general issue here. Evidence based medicine is widely perceived as being soul-less, and algorithmic: the last thing we’d want from doctors. This is a foolish misunderstanding. EBM 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, like clinical experience or patient preference. It is not about being an automaton. I believe you humanities graduates would call that a straw man argument.

That’s all a bit sensible: how about some more childish attacks, ideally involving fascism? Okay then. I will wear their label of “fascist” with a cheeky grin. But Archie Cochrane, on the other hand, pioneering epidemiologist, inspiration for the Cochrane Library, a prisoner of war for four years in Nazi Germany (“the main reason for my capture was my inability to swim to Egypt”) who has, from his abstracted position, probably saved more lives than any single doctor you know, might see it a little differently, since in 1936, he dropped out of medical school and travelled to Spain to join the International Brigade, where he fought genuinely violent totalitarian oppression, the fascists of General Franco, with his own two hands. Now. What did you do with your summer holidays?

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

You can read the full paper here.

Here‘s some handy and unambiguous background on what Evidence Based Medicine is and isn’t. It’s based on thus spectacularly influential and well-cited piece.

And while I’m in the mood for some links, here is an example of a Cochrane review, one of the most famous in fact, which includes an awful lot more than just “trials”, demonstrating how phenomenally ignorant the authors of this dismal social science piece were about evidence based medicine. I’m not going to re-read this Cochrane review right now, but it’s perfectly possible, given the question they were examining, that amongst the many other forms of data in there they may not actually have cited a single “trial”. Innumerable other Cochrane reviews will be similar in that regard.

Oh, and the ex-head of NIH favourably quoted the Holmes microfascism article recently.

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83 Responses

  1. Brendan said,

    August 22, 2006 at 8:25 am

    Squander Two: Anyone may criticise anything. But giggling at writing you don’t understand does not , by itself, constitute criticism.

    I have in mind just those bits of Ben’s article where he tosses out quotations from Deleuze and Guattari for us to laugh at. It may be that even in context and supported by the most careful exegesis, they turn out to be unintelligible. Or, they may be drawn from an unfamiliar philosophical idiom and do make sense if you take the trouble to immerse yourself in the relevant intellectual tradition. Or, they may be the victims of a terrible translation. Since Ben didn’t reference these two quotations, we can’t go and look for ourselves.

    For my part, having read Deleuze’s book on Leibniz, I think his work does make sense. But I didn’t find it sufficiently interesting or convincing to justify the immense labour of decyphering his wilfully obscure and allusive style.

  2. social scientist said,

    August 22, 2006 at 9:20 am


    Apologies. My second gripe was not a direct criticism of your good self. It is just that the conversation was taking a direction against non-scientists as opposed to bad science. Some of us are good at what we do and proud of that. Like scientists, when outsiders criticise our work generally and without adequate knowledge, we get a bit ruffled. But again, this wasn’t specifically meaning you.

    On the normative question, it is one of those words that crops up in social science articles often, which I don’t really like all that much because I do not fully understand but as far as I do understand it, as a political economist, a normative value is prescriptive in that it is a value that the holder wishes to establish as normal, based on the value holders pre-existing set of values. In other words it is an idealised notion of normal. Very Post Modern!

  3. Tessa K said,

    August 22, 2006 at 12:16 pm

    Superburger: >

    Yes there is. I had to wade through an awful lot of that crap while doing a degree and PhD in French. I read the French PoMos in the original, so no question of bad translations to obscure my understanding – which was that most of them were talking out of their derrières.

    If you have the misfortune to be at a university where PoMo is the standard approach to your subject, whether it’s literature, history, social science or anything else, you are going to get a pretty skewed idea of the subject – and then possibly apply that approach to other areas of knowledge and life.

  4. dlbuckley said,

    August 22, 2006 at 1:02 pm

    I notice that one of the authors of the Holmes et al paper lists a qualification as “PhD(cand)”. Does that mean they’re studying something strange, studying at a place I don’t know or that they haven’t actually got their PhD yet but are very confident?

    Is this normal or am I being an academic fascist?

  5. superburger said,

    August 22, 2006 at 3:49 pm

    I think PhD(cand) means they are a postgrad working towards a PhD — bit of a vanity title if you ask me, but maybe it’s the norm in Canada….

  6. Dr Aust said,

    August 22, 2006 at 7:05 pm

    Superburger –

    Know what you mean about the journals – the serious / major ones are almost all free online these days, though there are the few at the very top end that are so popular they can bar all but “personal” subscribers – Science is an example. But in the sort of realms we are dealing with (non-major journals) the “charge to access” thing is a bit suspicious – a;ways makes me think minor rubbish / scientific vanity publishing.

    Personally I don’t publish in the ones without free online access (I’m talking normal journals here, not the high-end ones), and nor will most other people I know – not so much for altruistic / idealistic reasons, but because it makes your work less likely to be read and (crucially) cited. If you are writing something and could equally well cite one or two or three papers for some point or other, you would pretty obviously cite the one you can read from your desk every time over the one you have to drag yourself to the campus library to consult – human nature.

  7. 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


    The bankruptcy of evidence-based practice?

    In this issue of the journal, there is a discussion on the
    phenomenon of evidence-based medicine (EBM) or evidence-
    based practice. Dave Holmes and his colleagues
    argue that EBM has some fascist characteristics. I am sure
    that this is not what Sackett et al. had in mind when they
    ‘invented’ the term EBM!

    Evidence-based medicine, according to Sackett et al., is
    ‘the integration of evidence with clinical expertise and
    patient values’.1 This articulates two things.
    First, the term evidence is very broad. It is not about
    searching ‘the truth’, using only randomised controlled trials
    or systematic reviews. This would lead to Evidence Biased
    Medicine! Evidence is not the same as ‘proof’ (although in
    the Netherlands we do not use distinctive words). Clinical
    experience and patient preferences or experiences are also
    regarded as evidence.

    Second, EBM is a process. It is a form of decision-making
    that takes place between a single patient and a single (or a
    group of) professional(s). Simply applying evidence in any
    form (studies, guidelines, patient preferences, etc.) without
    critical thinking is not evidence-based practice. It is hazardous
    practice. Also conducting a study or developing an
    evidence-based guideline is not EBM.
    It would be a pity for EBM to be regarded only as the use
    or development of ‘evidence’, without regard for the process
    of critical thinking. Critical thinking is not new in healthcare
    and evidence can only help us to make the right
    decisions; it cannot make the decisions for us. Letting evidence
    decide for us will lead to dangerous situations and
    potential harm to patients. This, of course, is conflicting with
    the Hippocratic oath: that is, first, do no harm. Applying
    evidence without any form of reflection might lead to harm.

    On the other hand, not applying evidence when it is appropriate
    might also lead to harm. It takes skill and knowledge
    to decide whether or not to apply evidence. To achieve this,
    we need excellent professional education to train our doctors,
    nurses and allied health professionals.
    Fortunately, we also have a great number of researchers
    and academics who can help these professionals, by constructing,
    aggregating and presenting evidence. In this issue
    there are two reviews of evidence. There is a systematic
    review of evidence on the professional practice of the nurse
    and developing and sustaining a healthy work environment
    in healthcare (Pearson et al.) and two comprehensive systematic
    reviews of evidence on aspects of undergraduate
    nursing curricula (Jayasekara et al.). We begin with a paper
    on implementing evidence on oral hygiene in two residential
    aged care facilities (Fallon et al.). This contribution
    relates very well to the discussion on the merits of evidencebased
    care in that evidence alone is not enough. It needs to
    be implemented and used in a proper and considered way.
    Let us hope that this evidence finds its way to the patient
    and is used as it should be used, that is, integrated with
    clinical expertise and patient values. I am positive that in this
    way, there is a promising future for evidence-based practice.

    Ruben van Zelm MSc
    Senior Advisor, Dutch Institute for
    Healthcare Improvement, Utrecht, the Netherlands

    1. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes
    RB. Evidence-Based Medicine – How to Practice and Teach EBM.
    New York: Churchill Livingstone, 1997.

  8. katem said,

    August 23, 2006 at 9:30 am

    Int J Evid Based Healthc 2006; 4: 187–190

    Letters to the editor

    Never mind the evidence, feel the width:
    a response to Holmes, Murray, Perron
    and Rail

    Holmes et al.’s paper in this issue ‘Deconstructing the evidence-
    based discourse in health sciences: truth, power and
    fascism‘ is most fascinating and provocative. I applaud the
    authors for their boldness, and the editor for agreeing to
    publish what might appear to be an attack on the very
    approach for which this journal stands, evidence-based practice
    (EBP). I agree with many of the views expressed, not
    least the authors’ dismay at the creeping uniformity and
    scientisation of scholarly journals, although I believe this can
    be attributed to Americanisation rather than the evidencebased
    practice movement (EBPM). The paper has many fine
    qualities but, for reasons of space, this response focuses on
    some important judgements and claims that I believe should
    be moderated if not entirely rejected.

    Although it is unclear how seriously its substance should
    be taken, the style of the paper, with its overblown phraseology
    set alongside neat sloganising, makes the intent of the
    authors clear enough. They wish to use their prodigious
    writing talents to subvert what they see as an exclusionary
    discourse operating across healthcare generally and nursing
    in particular. Despite some ‘fall-out’ to the contrary, their
    efforts are directed not at evidence-based practice per se,
    but rather at the hegemonic discourses associated with the
    EBPM, which seek to exclude ‘alternative forms of knowledge’.

    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 EBPM 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.
    Those who promote EBP, as well as those who
    attempt to translate it into practice, actually express a wide
    range of opinions about its role and importance, and have
    consistently laid it open for critical analysis and comment.
    By way of evidence to support this claim, we may note that:
    • For at least a decade, the international colloquia held by
    the Cochrane Collaboration have included substantial discussion
    on the value of quasi-experimental and qualitative
    research and how to incorporate the evidence into
    systematic reviews.

    • The Joanna Briggs Institute in Australia has made significant
    progress in formalising the role of interpretive research in
    considerations of what constitutes ‘evidence’ and how it
    should impact on practice. This has emerged from a collaboration
    involving not only clinicians and managers, but
    also individuals and organisation these authors would
    regard as ‘insiders’, emblematic of the EBPM.
    • Contributions to clinical publications, such as the British
    Medical Journal, are frequently critical of EBP and seek to
    ‘put it in its place’. Objections are often centred on the
    fear of eliminating clinical judgement (and with it the
    mystique and authority that goes with medical power),
    but they are also often about the technical aspects of
    defining and evaluating ‘evidence’, and the shortcomings
    of randomised controlled trials (RCTs) as the primary
    authority for practice. The Cochrane approach to EBP is
    by no means established as the new orthodoxy, as the
    authors of this paper assume, and published and informal
    critical debate is flourishing.

    • Many institutions that might be thought champions of
    EBP acknowledge that non-positivist research offers a
    valuable source of evidence. Leading funding bodies
    have begun to welcome qualitative research initiatives,
    and there is a new interest in the clinical arena as to
    what contribution different types of knowledge can
    make. So, not only are qualitative research journals thriving,
    but the number of research reports standing outside
    the positivist and post-positivist tradition now appearing
    in refereed journals, including the most orthodox mainstream
    medical journals, has increased significantly in
    recent years rather than diminished under the EBP

    Perhaps the authors identify the Cochrane database with
    EBP and the EBPM because it lends weight to their depiction
    of the EBP discourse as driven by a homogenous ideology,
    with a single philosophy of science (post-positivism), ‘excluding
    alternative forms of knowledge’, and devoted to a
    single research design, the RCT. Nevertheless, this claim is
    hard to understand, because the Cochrane organisation is,
    after all, just another organisation with an agenda, a web
    page and enthusiastic proponents. It is having a hard time
    actually advancing its views, despite what these authors
    claim. The EBPM has been successful in modifying some
    clinical practice but, as the debates in the journals testify,
    the clinical establishment – especially the medical establishment
    – is extremely reluctant to change practices, even in
    response to unequivocal RCT evidence. Familiarity with a
    product or procedure ensures that the clinician, often simply
    by dint of habit, will persist with it long after its ‘use by date’,
    and this is one reason why there is a ‘theory–practice’ gap,
    that is, a gap between what ought to be done according to
    the evidence and what is actually done.

    The authors note that the Cochrane database regards
    ‘acceptable research’ only as that based on RCTs. What the
    wider EBPM argues, however, is that knowledge claims
    should be weighed in accordance with the hierarchy of
    evidence on which they are based, with RCTs at the top and
    ‘expert opinion’ at the bottom. It is accepted that there are
    whole areas of clinical practice for which the best available
    knowledge may be derived from a research profile located
    considerably below RCTs on that hierarchy, and that in some
    cases it may not be possible or necessary to move beyond
    that level. To convert this into a totalising system – in which
    research is either ‘acceptable’ or ‘unacceptable’ – is thus a
    misrepresentation of the EBPM. Likewise, the authors say
    that as ‘one of the requirements of the Cochrane database
    is that acceptable research must be based on the RCT design;
    all other research, which constitutes 98% of the literature,
    is deemed scientifically unsound or imperfect’.1 This is a
    meaningless criticism, however, because no research is completely
    ‘sound’ or ‘perfect’; knowledge is always incomplete,
    inadequate and provisional. The authors say that EBP is
    problematic as ‘almost all “evidence” produced in the health
    sciences (see Traynor, 2002) is excluded from the supposed
    “evidence based” health sciences . . .’ Once again, however,
    it is not a case of evidence being excluded, but rather that
    – consistent with the Popperian epistemology – generalisations
    about what constitutes best practice must be based on
    whatever evidence is to hand, until better evidence becomes
    available. The EBP approach asks that clinicians be critical of
    the evidence they take into account, rather than ‘exclusionary’
    or ‘microfascistic’.

    Along the same lines, although, in Foucauldian terms, EBP
    may amount to a ‘regime of truth’, the authors are wrong
    to depict the EBP literature as claiming that ‘. . . certain
    research results (especially those obtained through RCTs)
    produce truth’. Such a claim would be at odds with EBP’s
    post-positivist epistemology, which takes a pragmatic view
    of knowledge, that is, it is valued for its ‘performativity’. The
    idea is not to establish the ‘truth’ but rather to find out ‘what
    works’. What constitutes ‘best practice’ from an EBP perspective
    is always a provisional recommendation, subject to
    revision as better evidence becomes available, exactly as
    Popperian post-positivist epistemology requires. EBP aspires
    not to produce ‘truth’ but to produce better outcomes.

    Again, the authors have set up a ‘straw man’ to knock down.
    Ironically, if the EBPM is ‘outrageously exclusionary and
    dangerously normative with regards to scientific knowledge’,
    it is no more so than the Deleuzian discourse, or authors
    who choose it as the vehicle for their politico-intellectual
    ambitions. Indeed, the fascistic exclusivity that the authors
    attribute to the EBPM reaches almost pathological levels in
    the work of Deleuze and Guattari, and this generates an
    instrument with which to conduct a sustained blitzkrieg,
    barely comprehensible to the outsider, against whatever
    offends the sensibilities of the cognoscenti. Many commentators
    note that to understand it requires knowledge of
    Spinoza, Nietzsche, Marx, Freud and Heidegger, and this
    must surely assign ‘outsider’ status to most readers of this
    journal. Furthermore, although the authors explain their
    rationale for using the term ‘fascism’ to refer to any structure
    that arises out of an ideology that excludes other forms of
    knowledge, this 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.

    Finally, in addition to the obscurity of the medium, the
    Deleuzian agenda, although claiming a Marxist heritage, is
    unremittingly radical and bleak, rejecting the possibility of
    both reform and revolution, and leaving the individual to
    retreat into a shell. It is, to carry military allusions a little
    further, a ‘philosophy of the trenches’: one can neither
    escape nor attack, only ‘make do’ in the mess one finds
    oneself. ‘Making do’ can include complaining effusively
    without offering any prospect of defensible intellectual positioning
    or effective social action. It is a pity that these
    authors choose this option because they demonstrate all the
    qualities needed to lead the debate forward in a constructive
    way that would benefit academics, clinicians and ultimately
    those who use health services.

    Colin A Holmes BA(Hons) TCert MPhil PhD MRCNA
    School of Nursing Sciences, James Cook University, Townsville,
    Queensland, Australia

    1. Traynor MJ. Purity, conversion and the evidence-based movements.
    Health 2000; 4: 139–58.

  9. ceec said,

    August 23, 2006 at 11:08 am

    brilliant – obviously not all the journal’s authors are fools. Thanks katem for posting those.

  10. Squander Two said,

    August 23, 2006 at 12:01 pm

    > giggling at writing you don’t understand does not , by itself, constitute criticism.

    It does if your criticism of it is that it’s incomprehensible. You yourself describe Deleuze’s style as “wilfully obscure”. That’s damning, as far as I’m concerned. While the use of specialist jargon is arguably inevitable in academic disciplines, the writer’s aim should be to try and be as intelligible as possible despite the jargon, not to deliberately crank the jargon up a notch to make it even harder for their readers to understand them.

    I direct the jury’s attention to Russells’ ABC of Relativity. Difficult ideas are no excuse for incomprehensibility.

  11. superburger said,

    August 23, 2006 at 1:57 pm

    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.

    Is it the norm in journals to put a list of ones degrees and affilialtions? I know in physics/chemistry/biochemistry journals it’s just a name and some indication of the corresponding author (ususally the big-dog prof. leading the group.)

  12. Brendan said,

    August 23, 2006 at 3:16 pm

    Squander Two: obscure is not the same as incomprehensible. I understood Deleuze’s book on Leibniz. So that part of his work at least is not incomprehensible.

    It took a great effort to work out what he had to say, and having done so, I judged that he could have expressed it more directly and accessibly, but chose not to. That’s why I think his style is *wilfully* obscure.

    If (as I do) you endorse the critique of Deleuze in the later paragraphs of the reply to Holmes supplied by katem (thanks katem!), you cannot also maintain that Deleuze is incomprehensible. His work cannot be a nihilistic philosophy of the trenches that makes unreasonable demands on readers, etc., and also be meaningless.

    Of course writers should aim at clarity and yes Russell was a master at it.

    The point is, you cannot judge at a glance that a writer has cranked up the jargon needlessly. You have to do the hard exegetical work first: work out what the message is and find a clearer way to say it. Then you have a case.

    The mere fact that you do not understand something does not show it to be unintelligible. Proof: try to read a text written in a language that you personally do not know.

    “I don’t understand it, ergo it’s incomprehensible” commits the same fallacy as “she won’t sleep with me, ergo she’s a lesbian or frigid”.

  13. Dr Aust said,

    August 23, 2006 at 4:17 pm

    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.

    An interesting demonstration of the difference between evidence-based scholarship (the critique) and ideology-driven polemic, as well as between writing with clarity and writing to obfuscate.

  14. CDS said,

    August 24, 2006 at 12:18 am

    If you’re going to call this ‘post-modernist bollocks’, you should at least do it properly in your best French accent and call it ‘outrageous post-modernist bollocks’. Which it is.

  15. jwicc said,

    August 24, 2006 at 6:17 pm

    I know I’m a bit late on this – but in case anyone is still looking at this thread I want to lend some support to Brendan’s case. For the record I think that the whacky article that starts it all off is very poor and I like and find its discussions very valuable. But I also think that quoting things out of context so that they sound difficult and silly so that one can then sniggering at them is indeed unbecoming. Worse, it repeats the offence of all those who grab bits here and there out of some scientific study in order to have a go at science or use it to promote some daft idea.

    Deleuze’s philosophy is very interesting indeed. He was an impressive thinker with a very wide reach and a singular vision of how the world might be experienced and lived in. His work is difficult but I think not deliberately obscure – though certainly esoteric.

    Firstly, because like a lot of philosophical writing (though not all) it is very conscious of the way in which it is responding to other, prior, philosophers and the way they used concepts and terms. For that reason one needs to know a lot about the history of philosopy to read Deleuze (to know, for instance, that the sentence quoted by Ben is addressing a large ongoing dispute about the philosophical concept of structure – and I specify ‘philosophical concept’ because it isn’t concerned with the engineers’ concept of structure).

    Secondly, because Deleuze like many, but not all, philosophers uses a style of writing intended to give readers a particular experience – this is true of Plato, or Spinoza, or Hegel and many othes. In Deleuze’s case he does indeed want to disorient readers somewhat. Not all people – perhaps Tessa is one – care for that experience. But it is not illegitimate. Asking why Deleuze writes in this difficult not – clear way is the same as asking why Joyce wrote Ulysses the way he did, or why Shakespeare sometimes has people speak in verse rather than in the way people ordinarily speak. Ask it in order to find out an answer rather than as a rhetorical objection to what someone has written.

    Clarity is not the only possible virtue of writing. Shakespeare could have written ‘Juliet, you look really nice’ which would have been clearer than what he did write. And that takes us onto Tessa K.s and Dr. T’s mocking of the idea that there may be ‘other ways of knowing’. That was the most depressing part of these comments. I certainly think that I come to know something about the world from a Wordsworth poem just as I come to know something about it by studying botany. And just because I think some works of art help me understand something about some illness I have doesn’t mean that I am stupid and won’t go to a properly trained doctor. One apprehends the world at many levels.

    What some ‘humanities-inclined’ people are guilty of is not appreciating the immense insight and even emotional as well as intellectual power of the scientists apprehension of the world – and what it can enable us to do in the world. They haven’t read enough Francis Bacon. But they won’t be brought to see that if the scientific community treats them with unscientific prejudical contempt.

    I particularly object to the attacks on the word normative – attacks clearly made as showy polemic that, in the way they respond to Spinoza’s polite attempts to inform, indicate that those posting them are not actually interested in sharing and learning from each other at all.

    Is it really hard to understand the difference between these two sentences –

    Normally people are heterosexual.
    Normal people are heterosexual –

    and the implications behind each of them?

    The specialisation of knowledge has become very intense. I expect that there are areas of scientific discovery that are somewhat opaque to some of the scientists who comment here. But if we respond to that specialisation by putting up walls, by treating others with contempt or by saying that nobody can possibly have anything to say about my subject unless they say it in exactly the way I specify – then we we all doomed.

    Can’t the bad-science community do better?


  16. KieronF said,

    August 24, 2006 at 7:13 pm

    As far as I can see this paper isn’t mainstream social science (at least not any kind of social science I’m familiar with, as a scientist turned social scientist). It seems to come from the largely English Literature-inspired ‘critical theory’ tradition… This is not to say that there is no validity in viewing EBP as a ‘discourse’… of course it has elements of a political project with its own rhetoric etc. This doesn’t mean it is ‘bad’, and we should be able to recognise the reality that science is a social phenomena whilst still recognising that it is by far the most successful social institution ever to make knowledge claims… It should also be remembered that the policy decisions to significantly boost science spending in the UK since 2000 were all made based on evidence produced by social scientists…

  17. glacial said,

    August 25, 2006 at 10:24 am

    1. The article can be condemned as inaccurate in places, inaccessible to many (including many of the target audience of the Journal), and containing hyperbole.
    2. Linking someone who was demonstrably anti-factist to a facist action or though is offensive. As incidently is the implication that those post-positivist scientists/decendents of scientists who were victims of 20th Century facism are in fact themselves facists.
    3. Social science, for example, provides valuable paradigms with which to address or examine issues such as societal engagement in science, access to knowledge and experimental design. Philosophy is the basis for the scientific method and is deserving of respect.
    4. Doubtless the authors don’t give a monkey’s about what I or you say.

    An excellent thread I thought. I particularly appreciate the fact that there were several rants, of different perspectives, yet to your collective credit apologies flowed forth when offense was unintentionally given. So much more constructive than merely labelling those who don’t agree with you. Also enjoyed James’ and others’ efforts to educate us on Deleuze etc. Thank you for your patience.

  18. coracle said,

    August 25, 2006 at 10:49 am


    Apprehension or appreciation? Paragraph 6 line 3

    Different ways of portraying the world are fine for art, but not for scientific discourse where evidence and not subjectivity is critical.

  19. ceec said,

    August 25, 2006 at 11:59 am

    Ah yes! Evidence with no subjectivity! Of course. That’s what scientists do. Ever seen any old psychiatry textbooks? Of course NOW, we wouldn’t believe in any of that stuff, would we?

  20. coracle said,

    August 25, 2006 at 3:31 pm

    Which is why there was a multi-page wrangle on the forum about whether psychology qualifies as a science.

    Not that I claimed science is entirely free of subjectivity, simply that it places high value on minimising subjectivity, unlike the authors of microfascism.

  21. superburger said,

    August 25, 2006 at 4:03 pm


    That’s a lovely discourse on philosophical writing.

    But in the context of Holmes’ article you are missing one crucial point: what they have written is simply untrue.

    One can write with as flowery prose as one wishes if a)what you are saying is true or b)what you are saying is subjective.

  22. bishop said,

    August 25, 2006 at 4:24 pm


    If you were bothered to find out a little about postmodernism, you’d find that psychiatry was one of its main targets, precisely due to its reliance on supposed expertise that was actually the exercise of social power. Postmodernist thought and practice has transformed society, and particularly medical practice, and it is in no way incompatible with a rational, materialist worldview. The letter from Colin Holmes, the one that had everyone applauding, goes some way to revealing EBM as including that ‘critical thinking’ rather than in opposition to it.

  23. Squander Two said,

    August 26, 2006 at 12:58 am


    I often get accused of extreme literal-mindedness, but, on this occasion, I was using the word “incomprehensible” in its broader, less literal sense, as it is often used, and as I made clear by adding “make it even harder” — not impossible — “for their readers to understand them.”

    > It took a great effort to work out what he had to say, and having done so, I judged that he could have expressed it more directly and accessibly, but chose not to. That’s why I think his style is *wilfully* obscure.

    Yes, that’s what I said.

    > you cannot judge at a glance that a writer has cranked up the jargon needlessly.

    I didn’t. I took your word for it.

    However, you can judge at a glance that a writer has not put sufficient effort into piercing through the jargon.

    > The mere fact that you do not understand something does not show it to be unintelligible. Proof: try to read a text written in a language that you personally do not know.

    Wow. That’s some serious condescension you’ve got there. Teach a lot of primary-school kids at Hertfordshire, do you?

  24. Dr Aust said,

    August 26, 2006 at 2:17 pm

    Jwicc wrote:

    “Clarity is not the only possible virtue of writing.”

    I agree for writing in the broad sense, but we are NOT talking here about poetry or literature, or in any way building an “atmosphere” through language. Quite the reverse: we are talking about writing in an arena where the goal is to communicate one’s thoughts, meaning and logic as cleary as possible. So in scientific writing, clarity as an aim far exceeds any other goal/virtue.

  25. jwicc said,

    August 26, 2006 at 8:41 pm

    Sorry – meant to come back to this sooner.

    Coracle – I did mean ‘apprehension’. Are you sure that scientists don’t ‘portray the world’ in different ways? Sure, its not ALL that scientists do but it is part of it, and part of being a scientist is getting your mind in to a state where you can apprehend things that are not intuitive or common sense and come to see things anew.

    I am sure you wouldn’t say that scientists can say everything there is to say or apprehend all things. I guess I am saying that there is more to be said than science but that it is a vast error to think that this in some way means that science is of itself bad or to be bypassed.

    And Dr. Aust – well, yes, in science the intention is to communicate so that others can replicate. But that isn’t (clearly) what the authors of the original article were trying to do. I think they were trying to create a mood (they even start by saying that using the term fascist will provoke a response). I don’t think there is anything wrong with that. What’s wrong with the article from my perspective is that it parades as novel and important a rather banal claim – that we wouldn’t want to focus on the ‘evidence-based’ to such an extent that we automatically reject in advance any claim made in within a different framework. Their worst offence is to assume that this would be news to scientists – the best of whom have always ‘thought outside the box’.


  26. ceec said,

    August 29, 2006 at 4:56 pm

    Bishop – not sure I understand your point. I only meant that knowledge is situated and that what we think of as truth or evidence one minute may just turn out not to be truth or evidence the next. Science proceeds using different paradigms at different times. That’s not to say one paradigm is irrational per se, just that rationality depends rather on where you are and when. Er… Gallileo, quantum physics, punctuated equilibrium etc. etc. all throwing up new questions about old paradigms.

    On the other hand, maybe you really think that there is one immutable way to be rational and critical, which is a little disturbing in the light of the evidence from human history. All science proceeds according to current power structures and people find it very hard to extract their thought processes from their social environments. I know psychiatry is an easy target but there are plenty more examples (e.g. the ones above).

  27. tom smith said,

    August 31, 2006 at 10:35 am

    The labels do much damage but their uncritical, and deliberate, misuse in present clinical practice generates the “exclusionism” and “normalisation” of clinical science. Throw in the cloying ignorance of middle management in the new NHS and one wonders how any serious innovation can take place ? Cochrane lived in another age and another world; he would have been the first to deprecate the present situation.

    EBM may be the “lowest form of acceptable clinical practice” though in the taxonomy above it, evidence-sensitive medicine, evidence-aware medicine and patient-centred medicine may be worthy and achievable ? Each requires varying degrees of reflection, awareness, creativity and communication beyond the standard guideline, RCT or meta-analysis.

    Popperian, hypothetico-deductive “science” clearly has its place, as does Kuhnian inference, and, Bohmian creativity. There are many other ways of “knowing” as many contributions have already suggested. EBM was a fashion, that was embraced by politicians, and has distorted the essence of clinical practice, and, the “art” of medicine – lets hope its days are numbered !

  28. psybertron said,

    September 1, 2006 at 3:36 am

    Well said James and Tom.

    It’s a pity so many scientists cannot see that there is more to scientific thinking and knowledge than objectivity and logic. Fortunately the best scientists always have.

    Yes, they are crucial to disproving hypotheses empirically, but much progress in developing hypotheses involves thinking out of the box, outside the straight-jacket of received wisdom.


  29. Ben Goldacre said,

    September 1, 2006 at 3:40 am

    “It’s a pity so many scientists cannot see that there is more to scientific thinking and knowledge than objectivity and logic. Fortunately the best scientists always have.”

    who did you have in mind?

  30. Dr Aust said,

    September 1, 2006 at 5:56 pm

    “It’s a pity so many scientists cannot see that there is more to scientific thinking and knowledge than objectivity and logic. Fortunately the best scientists always have.

    Yes, they are crucial to disproving hypotheses empirically, but much progress in developing hypotheses involves thinking out of the box, outside the straight-jacket of received wisdom.”

    This second bit is a bit like saying “the BEST piano players have always known that playing the piano involves MUCH more than being a technically skilled pianist” … and ignoring the fact that you have to be technically skilled pianist FIRST to play like Andras Schiff. So in science you must have the basic technical knowledge, background and grasp, and understanding of logic and evidence and data, before your flights of fancy are going to take you anywhere

    One of the things working in science teaches you is that ideas are cheap. You can have loads of “Maybe..” “What if…” moments a day, but sitting around thinking grand thoughts doesn’t really get you very far (unless you are RP Feynman). After you have had your grand idea you have to ask “What is the evidence for it?” “What is the evidence against it?” “What would the critical experiment be?” and so on.

  31. psybertron said,

    September 27, 2006 at 3:32 am

    Ben, Dr Aust addresses the point, then suggests I suggested “ignoring” the necessary aspects of scientific method. I suggested, nay stated, entirely the opposite.

    I’m clearly saying that is necessary, but not sufficient.
    “More than” I said, in fact.

    Flights of fancy is one pejorative way of characterizing the missing ingredient. It’s clearly something more than that – art, intuition, direct experience, you name it – something hard to pin down with logic and objectivity (obviously, by definition) but not to be ignored just because it doesn’t fit the objective mould.

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