"Malaysia Prime Minister Mahathir Mohamad and the Sultan of Johor are seen in a blue Proton Saga... "When asked whether there is any tension with the sultan, Dr Mahathir said: “No, I don’t see anything because I went to see him and he drove me to the airport. I don’t want to comment on the sultans because if I say anything that is not good then it’s not nice because he is the sultan”"

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Friday, April 26, 2019

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

Even in 2006 the rot was evident:

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

"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...

We can already hear the objections. The term fascism represents an emotionally charged concept in both the political and religious arenas; it is the ugliest expression of life in the 20th century. Although it is associated with specific political systems, this fascism of the masses, as was practised by Hitler and Mussolini, has today been replaced by a system of microfascisms – polymorphous intolerances that are revealed in more subtle ways. Consequently, although the majority of the current manifestations of fascism are less brutal, they are nevertheless more pernicious...

Within the healthcare disciplines, a powerful evidencebased discourse has produced a plethora of correlates, such as specialised journals and best practice guidelines. Obediently following this trend, many health sciences scholars have leapt onto the bandwagon, mimicking their medical colleagues by saturating health sciences discourses with concepts informed by this evidence-based movement. In the words of Michel Foucault, these discourses represent an awesome, but oftentimes cryptic, political power that ‘work[s] to incite, reinforce, control, monitor, optimize, and organize the forces under it’ (p. 136). Unmasking the hidden politics of evidence-based discourse is paramount, and it is this task that forms the basis of our critique...

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.

At first glance, EBHS [Ed: evidence-based health sciences] seems beneficial for positive patient outcomes, which is a primary healthcare objective...

EBHS comes to be widely considered as the truth. When only one method of knowledge production is promoted and validated, the implication is that health sciences are gradually reduced to EBHS. Indeed, the legitimacy of health sciences knowledge that is not based on specific research designs comes to be questioned, if not dismissed altogether. In the starkest terms, we are currently witnessing the health sciences engaged in a strange process of eliminating some ways of knowing. EBHS becomes a ‘regime of truth’, as Foucault would say – a regimented and institutionalised version of ‘truth’...

We believe that health sciences ought to promote pluralism – the acceptance of multiple points of view. However, EBHS does not allow pluralism, unless that pluralism is engineered by the Cochrane hierarchy itself... the evidence-based movement is neither ‘progressive’ nor a ‘natural’ development in health sciences: it is a trend that is engineered. As a response to this, a vigilant resistance must arise from within the health disciplines themselves, and one way of deploying such resistance is by using a tool called ‘deconstruction’...

We believe that EBM [Ed: evidence-based medicine], which saturates health sciences discourses, constitutes an ossified language that maps the landscape of the professional disciplines as a whole. Accordingly, we believe that a postmodernist critique of this prevailing mode of thinking is indispensable. Those who are wedded to the idea of ‘evidence’ in the health sciences maintain what is essentially a Newtonian, mechanistic world view: they tend to believe that reality is objective, which is to say that it exists, ‘out there’, absolutely independent of the human observer, and of the observer’s intentions and observations. They fondly point to ‘facts’, while they are forced to dismiss ‘values’ as somehow unscientific. For them, this reality (an ensemble of facts) corresponds to an objectively real and mechanical world. But this form of empiricism, we would argue, fetishises the object at the expense of the human subject, for whom this world has a vital significance and meaning in the first place. An evidence-based, empirical world view is dangerously reductive insofar as it negates the personal and interpersonal significance and meaning of a world that is first and foremost a relational world, and not a fixed set of objects, partes extra partes...

Arendt herself draws the link between totalitarian ideology and the modern sciences, and so we are justified to turn to her, among others, to find a trenchant critique of EBHS. The ‘regime of truth’ that has emerged from the EBM is an ideology that is supported by a number of contingent factors – contingencies that EBHS would mistakenly classify as ‘truths’. An ideology is monolithic: those who adhere to the ideology believe it ‘can explain everything and every occurence [sic] by deducing it from a single premise’ (p. 468). She warns that totalitarianism ‘is quite prepared to sacrifice everybody’s vital immediate interests to the execution of what it assume[s] to be the law of History or the law of Nature’ (pp. 461–462). But, as we have remarked, History and Nature are made; these forms therefore call for an ever-renewed critique...

Applying the work of Orwell in a critique of EBM in health sciences might surprise the reader; however, after an in-depth reading of 1984, we feel that Orwell’s vision is gradually becoming a reality. Currently, a large number of scholars in the health sciences follow their colleagues in medicine down a narrow path leading to uniformity and intolerance. There is therefore in our opinion, the creation and advancement of a new ‘language’ that is supplanting all others, attempting to discredit or to eliminate them from the discursive terrain of health. This is scientific Newspeak. It is a highly normative and recalcitrant scientific language that stands in opposition to that sense of hope that sustains every freedom-loving individual."


Remarkably no evidence is given for the grand claims made here - just the throwing out European names and the most tenuous of connections to the argument.

Dawkins's famous quote applies with very few changes:

"Show me a cultural relativist at thirty thousand feet and I’ll show you a hypocrite. Airplanes are built according to scientific principles and they work. They stay aloft and they get you to a chosen destination. Airplanes built to tribal or mythological specifications such as the dummy planes of the Cargo cults in jungle clearings or the bees-waxed wings of Icarus don’t."
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