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

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

Some of you might enjoy this absolute cracker from the current edition of the International Journal of Evidence-Based Healthcare: a critical theory deconstructionist attack on evidence based medicine and Cochrane centres, in a proper journal. Presumably I am a bit of a “microfascist” for posting it here.

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

Authors: Holmes, Dave; Murray, Stuart J1; Perron, Amélie2; Rail, Geneviève2

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

Drawing on the work of the late French philosophers Deleuze and Guattari, the objective of this paper is to demonstrate that the evidence-based movement in the health sciences is outrageously exclusionary and dangerously normative with regards to scientific knowledge. As such, we assert that the evidence-based movement in health sciences constitutes a good example of microfascism at play in the contemporary
scientific arena.
The philosophical work of Deleuze and Guattari proves to be useful in showing how health sciences are colonised (territorialised) by an all-encompassing scientific research paradigm – 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.

The Cochrane Group, among others, has created a hierarchy that has been endorsed by many academic institutions, and that serves to (re)produce the exclusion of certain forms of research. Because ‘regimes of truth’ such as the evidence-based movement currently enjoy a privileged status, scholars have not only a scientific duty, but also an ethical obligation to deconstruct these regimes of power.
Key words:
critique, deconstruction, evidence-based, fascism, health sciences, power.

From their opening line (“We can already hear the objections. The term fascism represents an emotionally charged concept in both the political and religious arenas”) you can hear the authors relishing their own controversy, but amazingly, even that is not quite as annoying as the way they bang on about the Cochrane collaboration and hierarchies of knowledge, rather triumphantly, but without demonstrating that they understand the reasons why a good meta-analysis provides more compelling evidence than a good systematic review, which in turn provides more compelling evidence than an individual trial, and so on.

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

Archie Cochrane as a Captain with the International Brigade fighting Franco’s fascists in 1936

And this nonsense attacking EBM is not an isolated example, of course: the excellent journal Social Science and Medicine recently this paper on alternative therapies and evidence which, although not quite as absurd as Holmes above, does suggest there may be a growing movement. If you have any more examples, do please, always, send them my way, I’m going to start writing on this soon.

Anyway, excellent background and devastating critiques of this kind of fashionable nonsense can be found in the work of Levitt and Gross, and of course this whole scene met its match with the mighty Alan Sokal, a physicist who wrote a deliberately meaningless spoof postmodernist critique of physics, and then got it successfully published in “Social Text”, a leading journal in the field.

Since this is a slightly tricky journal to get hold of, I’ve pasted a few quotes below. Entirely unrepresentative quotes of course, selected just to make the authors look bad. No, hang it all, here’s the whole of their final section, if they want to be copyright fascists about it then let them come.

Final remarks

Critical intellectuals should work towards the creation of a
space of freedom (of thought), and as such, they constitute
a concrete threat to the current scientific order in EBHS and
the health sciences as a whole. It is fair to assert that the
critical intellectuals are at ‘war’ with those who have no
regards other than for an evidence-based logic. The war
metaphor speaks to the ‘critical and theoretical revolt’ that
is needed to disrupt and resist the fascist order of scientific
knowledge development.
The evidence-based enterprise invented by the Cochrane
Group has captivated our thinking for too long, creating for
itself an enchanting image that reaches out to researchers
and scholars. However, in the name of efficiency, effectiveness
and convenience, it simplistically supplants all heterogeneous
thinking with a singular and totalising ideology.
The all-embracing economy of such ideology lends the
Cochrane Group’s disciples a profound sense of entitlement,
what they take as a universal right to control the scientific
agenda. By a so-called scientific consensus, this ‘regime of
truth’ ostracises those with ‘deviant’ forms of knowledge,
labelling them as rebels and rejecting their work as scientifically
unsound. This reminds us of a famous statement by
President George W Bush in light of the September 11
events: ‘Either you are with us, or you are with the terrorists’.
In the context of the EBM, this absolutely polarising world
view resonates vividly: embrace the EBHS or else be condemned
as recklessly non-scientific.
In conclusion, in The Human Condition, Hannah Arendt
points to one way to combat totalitarianism. For Arendt, the
opposite of totalitarianism is politics, by which she means,
politics guided by free speech and a plurality of views:
“speech is what makes man a political being. If we would follow
the advice, so frequently urged upon us, to adjust our cultural
attitudes to the present status of scientific achievement, we
would in all earnest adopt a way of life in which speech is no
longer meaningful.” (pp. 3–4)27
When the pluralism of free speech is extinguished, speech
as such is no longer meaningful; what follows is terror, a
totalitarian violence. We must resist the totalitarian program
– a program that collapses words and things, a program that
thwarts all invention, a program that robs us of justice, of
our meaningful place in the world, and of the future that is
ours to forge together. Paradoxically, perhaps, an honest
plurality of voices will open up a space of freedom for the
radical singularity of individual and disparate knowledge(s).
The endeavour is always a risk, but such a risk is part of the
human condition, and it is that without which there could
be no human action and no science worthy of the name.
Plurality is the condition of human action because we are all the
same, that is, human, in such a way that nobody is ever the same
as anyone else who ever lived, lives, or will live.

Is it just me, or does all this talk of fascists remind you, ever so slightly, of Rik Mayall in the Young Ones?


Professor David Colquhoun (FRS), the excellently entertaining microfascist (sorry David…) who runs this ever vigilant page on quackery, has very kindly suggested that you might read the full paper here, and reminded me of this other recent gem in a similar vein.

There are also some more great examples in the comments below, including this.

(And if that had you shaking with laughter in your jackboots, you might also enjoy this mystery tale of Agatha-Christie-related postmodernist bollocks on science (or indeed this strange tale involving artificial intelligence, New Scientist, the Loebner Prize, and the Nazis (or indeed this))).

If you like what I do, and you want me to do more, you can: buy my books Bad Science and Bad Pharma, give them to your friends, put them on your reading list, employ me to do a talk, or tweet this article to your friends. Thanks! ++++++++++++++++++++++++++++++++++++++++++

86 Responses

  1. superburger said,

    August 15, 2006 at 1:25 am

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

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

  2. Dr Aust said,

    August 15, 2006 at 1:55 pm

    Few quickies:

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

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

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

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

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

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

    ‘Nuff said.

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

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

  3. superburger said,

    August 15, 2006 at 9:45 pm

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

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

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

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

  4. sockatume said,

    August 16, 2006 at 8:28 am

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

  5. warumich said,

    August 16, 2006 at 9:04 am

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

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

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

  6. Dr Aust said,

    August 16, 2006 at 10:42 am

    Hi Warumich

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

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

  7. superburger said,

    August 16, 2006 at 2:10 pm

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

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

    Is total drivel.

    Almost every papragaph contians something that is patently absurd.

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

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

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

  8. ceec said,

    August 16, 2006 at 11:31 pm

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

  9. ceec said,

    August 16, 2006 at 11:45 pm

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

  10. jj_hankinson said,

    August 17, 2006 at 12:05 pm

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


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

  11. oneoffmanmental said,

    August 17, 2006 at 12:11 pm

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

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

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

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

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

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

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

  12. Dr Aust said,

    August 17, 2006 at 1:12 pm

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

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

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

  13. ceec said,

    August 17, 2006 at 2:29 pm

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

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

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

  14. ceec said,

    August 17, 2006 at 4:04 pm

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

  15. Ben Goldacre said,

    August 17, 2006 at 4:06 pm

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


  16. ceec said,

    August 17, 2006 at 4:24 pm

    oops – chanting, not charming

  17. Dr Aust said,

    August 17, 2006 at 6:22 pm

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

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

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

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

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

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

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

  18. j said,

    August 17, 2006 at 9:44 pm

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

  19. Ben Goldacre said,

    August 17, 2006 at 11:34 pm

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

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

  20. warumich said,

    August 18, 2006 at 12:06 pm

    Dr Aust:

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

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

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

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

  21. warumich said,

    August 18, 2006 at 12:46 pm

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

  22. warumich said,

    August 18, 2006 at 1:32 pm

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

  23. superburger said,

    August 18, 2006 at 2:45 pm

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

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

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

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

  24. Ben Goldacre said,

    August 18, 2006 at 2:50 pm

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

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

  25. ceec said,

    August 18, 2006 at 3:08 pm

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

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

  26. ceec said,

    August 18, 2006 at 3:09 pm

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

  27. warumich said,

    August 18, 2006 at 3:16 pm

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


    But it’s really, really funny

  28. superburger said,

    August 18, 2006 at 3:20 pm

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

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

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

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

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

  29. StephenAWells said,

    August 19, 2006 at 4:01 am

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

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


    Didn’t think so.

  30. Michael Harman said,

    August 22, 2006 at 12:43 pm

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


  31. DrGlenn said,

    October 19, 2006 at 3:18 pm

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

  32. DrGlenn said,

    October 20, 2006 at 6:03 pm

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

  33. Psychobabbler said,

    October 29, 2006 at 12:41 pm

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


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

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

  34. Elo said,

    November 28, 2007 at 6:56 am

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

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

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

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

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  36. certaintyprinciple said,

    March 2, 2010 at 7:02 pm

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