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 Evidence Based Medical Microfascists
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Ghost_Skeptic
SFN Regular

Canada
510 Posts

Posted - 08/27/2006 :  01:18:01  Show Profile Send Ghost_Skeptic a Private Message
Since there has been a lot of discussion here about the term fascists

Here is a paper by a professor and 2 PhD candidates form the University of Ottawa (Canada) Shcool of Nursing and a professor of English at Ryerson University calling Evidence Based Medicine "microfacism".

quote:
Deconstructing the evidence-based
discourse in health sciences: truth,
power and fascism
Dave Holmes RN PhD,1 Stuart J Murray PhD,2 Amélie Perron RN
PhD(cand)1 and Geneviève Rail PhD1
1Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, and 2Department of English,
Ryerson University Toronto, Ontario, Canada
Abstract

Background Drawing on the work of the late French philosophers Deleuze and Guattari, the objective of this paper is to demonstrate that the evidence-based movement in the health sciences is outrageously exclusionary and dangerously normative with regards
to scientific knowledge. As such, we assert that the evidence-based movement in health sciences constitutes a good example of microfascism at play in the contemporary scientific arena.

Objective The philosophical work of Deleuze and Guattari proves to be useful in showing how health sciences are colonised (territorialised) by an all-encompassing scientific research
paradigm – that of post-positivism – but also and foremost in showing the process by which a dominant ideology comes to exclude alternative forms of knowledge, therefore acting as a fascist structure.

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


The rest of this nonsense can be read here

In a nutshell, they object to Evidence Based Medicine because it is unkind to woo woo and "other ways of knowing" (such as confirmation bias, ignoring placebo effects post hoctor proc fallacy etc.). If these people are typical of those educating nursing students in the province of Ontario, remind me not to get sick enough to require hospitilzation if I am in Ontario.

The real irony of their use of the term fascist is explained byhttp://www.guardian.co.uk/life/badscience/story/0,,1853711,00.htmlBen Goldacre in Bad Science as follows:
quote:
OK 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, who has, from his abstracted position, probably saved more lives than any doctor you know, might see it differently, since in 1936, he went to Spain to join the International Brigade, and fight the fascists of General Franco. Now, what did you do with your summer holidays?



"You can lead a horse to water but you can't make him drink. / You can send a kid to college but you can't make him think." - B.B. King

History is made by stupid people - The Arrogant Worms

"The greater the ignorance the greater the dogmatism." - William Osler

"Religion is the natural home of the psychopath" - Pat Condell

"The day will come when the mystical generation of Jesus, by the supreme being as his father in the womb of a virgin, will be classed with the fable of the generation of Minerva in the brain of Jupiter" - Thomas Jefferson

HalfMooner
Dingaling

Philippines
15831 Posts

Posted - 08/27/2006 :  03:44:14   [Permalink]  Show Profile Send HalfMooner a Private Message
That's bloody awful stuff, a paean in the defense of quackery. Thanks for posting this!

I'll admit to sometimes personally stretching the definition of Fascism to include what I call theonazis. Clearly, aside from the "Christian Identity" movement, most of the religious right are not classical Nazis or Fascists. But, in my defense, the fundies are something very similar to Fascists.

But the idiots you cite have totally, and probably deliberately missed the mark with their coined term, "microfascism." If anything is held in common by Fascism and other authoritarian movements and ideologies, it is a hatred for evidence. "The truth shall make you free" is more than a slogan, it's an antifascist program.

I shudder to think what would happen to medicine if these bozos were in control.


Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive.
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BigPapaSmurf
SFN Die Hard

3192 Posts

Posted - 08/28/2006 :  09:53:08   [Permalink]  Show Profile Send BigPapaSmurf a Private Message
So which Nation and Leader do these facists idolize? They must be Greek Reconstructionists...

This makes me sick, BTW.

"...things I have neither seen nor experienced nor heard tell of from anybody else; things, what is more, that do not in fact exist and could not ever exist at all. So my readers must not believe a word I say." -Lucian on his book True History

"...They accept such things on faith alone, without any evidence. So if a fraudulent and cunning person who knows how to take advantage of a situation comes among them, he can make himself rich in a short time." -Lucian critical of early Christians c.166 AD From his book, De Morte Peregrini
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beskeptigal
SFN Die Hard

USA
3834 Posts

Posted - 08/28/2006 :  23:46:22   [Permalink]  Show Profile Send beskeptigal a Private Message
I'll let you know what reply I get. I emailed the listed author asking for an example where EBM would fail and some other means of insight would succeed.
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HalfMooner
Dingaling

Philippines
15831 Posts

Posted - 08/29/2006 :  01:18:13   [Permalink]  Show Profile Send HalfMooner a Private Message
quote:
Originally posted by beskeptigal

I'll let you know what reply I get. I emailed the listed author asking for an example where EBM would fail and some other means of insight would succeed.

Great! A good, simple question indeed.


Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive.
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beskeptigal
SFN Die Hard

USA
3834 Posts

Posted - 08/29/2006 :  20:54:05   [Permalink]  Show Profile Send beskeptigal a Private Message
Dr Holmes responded right away. Here is the exchange so far.

Dr Holmes,
>
> Perhaps I do not understand the concept you are trying to convey in your
> recent paper, "Deconstructing the evidence-based discourse in health
> sciences: truth, power and fascism." However, I am extremely concerned about
> it's meaning as I understand it.
>
> If you are commenting just on the limited acceptance of criteria used to
> validate outcomes, then certainly we in the nursing and medical professions
> might need reminders to broaden our paradigm of what is valid evidence. But
> to claim evidence based medicine itself is too limiting of a concept takes
> nursing and medicine out of the realm of science and back to the days of
> using anecdotes and long standing myths to determine our practices.
>
> Medicine and nursing have only truly fully embraced the sciences in the last
> few decades. While some medical and nursing practices were developed from
> careful systematic observation, as recently as 50 years ago many medical and
> nursing practices were based on tradition and had never been systematically
> evaluated using the scientific method. Millions of useless and risky
> tonsillectomies are testimonies to that fact.
>
> Today a large percentage of the human population believe in medical nonsense
> such as Homeopathy and fear vaccines cause autism years after the evidence
> overwhelmingly shows there is no connection. The result is as a society we
> waste billions of dollars on unproven remedies, perhaps an amount of money
> that could provide proper medical coverage for every uninsured citizen in
> the USA. Parents have to be re-educated that vaccines prevent a vastly far
> greater disease burden than they cause as opportunities are missed to
> prevent those deadly diseases.
>
> The lack of using scientific evidence based medicine is not confined to the
> public. Decision making criteria such as "better safe than sorry", "it will
> ease the patient's fear", or "if I don't prescribe it another provider will"
> rather than a true risk benefit analysis was used by health care providers
> during the anthrax scare resulting in massive over-prescribing of
> Ciprofloxin at a time when we face a critical challenge of antibiotic
> resistant pathogenic bacteria.
>
> I see inappropriate medical decisions regarding prophylaxis after exposure
> to blood or other potentially infectious materials on a weekly basis. This
> is after 10 years of CDC's standardized recommendations for that prophylaxis
> which was developed using careful scientific method and collecting hundreds
> of research papers to base the recommendations on.
>
> I ask you to give me an example where evidence based medicine has limited
> current practice and how one is supposed to determine the best practice if
> not by the scientific method? Or explain to me what it is about your paper
> that I failed to understand.
>
> Thank you for taking the time to read my comments. A reply is most
> anticipated.

From: "Dave Holmes" <dholmes@uottawa.ca>
> Hi there
>
> Thanks for reading our paper. The best way to answer to your
> questions/comments is to bring the discussion where it belongs: epistemology
> /research paradigms.
>
> The objective of the paper is certainly not to promote homeopathic meds,
> none immunization of children, etc. The aim is to critique a single approach
> to developing knowledge in bio/medical fields. The scientific analysis of
> anecdotes formally known as qualitative research can also lead to finding
> and verifying evidences. Why are RCTs portrayed as the gold standard when
> many practitioners recognize the patient before them is not an 'average'?
>
> Our paper is a call for debate, although a strong call I admit but a call
> nonetheless.
>
> To answer your question, I guess that a thorough reading of G. Canguillhem,
> The Normal and the Pathological would be a good start - he is a French
> philosopher of science.
>
> Regards.
>
> Dave
>
> Dave Holmes, Inf., PhD / Dr Dave Holmes, RN.
>
> Professeur agrégé/Associate Professor
> Université d'Ottawa/University of Ottawa
>
> Faculté des sciences de la santé/Faculty of Health Sciences; École des
> sciences infirmières/School of Nursing
>
> Faculté de médecine/Faculty of Medicine; Département de
> psychiatrie/Department of Psychiatry
>
> 451 Smyth Road
> Ottawa, Ontario
> Canada
> K1H 8M5
> 613.562.5800 (8341) (P)
> 613.562.5443 (F)
>
Dr Holmes,

Thank you for such a rapid response.

I take issue then with the paper where it appears to equate clinical trials with evidence based medicine. If that is a correct impression, I would consider it an anemic view of science and evidence.

You mention anecdotal evidence as qualitative. But the issue with anecdotal evidence is not that it isn't valid evidence. The issue is the human brain has an innate capacity to seek out patterns. Those who do not understand the scientific process have a tendency to believe causation with single events which the individual perceives to be connected. In addition, incorrect conclusions drawn on anecdotal evidence are frequently passed on and can become part of the 'common knowledge' base of many individuals rather than just the one who initially experienced the event. When collected as evidence and properly evaluated, anecdotal evidence is as useful as clinical trials depending on the study.

I am now wondering if this anemic view of evidence is a result of spending more time with the medical model than the nursing model of care. This is not to say all health care providers practice within the narrow confines of either model. As a nurse practitioner, I certainly use both. But the medical model of care would tend to focus on clinical trials of pharmaceutical and surgical interventions.

The nursing model of care encompasses the whole patient and his or her surroundings. In other words, the nursing model is patient based while the medical model is disease based. As a nurse scientist I frequently find myself explaining to physical scientists how one collects and analyzes data that isn't as easily measured and teased out as, for example, measuring gravitational force. But once physical scientists are enlightened to the scientific methods of the human sciences, they have no trouble understanding that the scientific process applies to complex systems such as humans are.

I invite you to consider whether your concern is over evidence based medicine or over the excessive reliance on clinical trials. As to the latter, I assure you I, for one, have no trouble seeking and using all sorts of evidence. Clinical trials are only a small percentage of the evidence I utilize in my practice decisions. But the key remains evidence based medicine. Anything else is foolish.

To equate clinical trials with the scientific process and evidence based medicine is to not understand what the scientific process really is.

Again, forgive me if my reply is based on misunderstanding the premise of your paper. A philosopher I am not and I admit to not fully understanding all you are putting forward in your paper.



Edited by - beskeptigal on 08/29/2006 20:54:26
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HalfMooner
Dingaling

Philippines
15831 Posts

Posted - 08/29/2006 :  22:32:54   [Permalink]  Show Profile Send HalfMooner a Private Message
Thank you so much for posting this, B. So far, I get the impression that Dr. Holmes is beating around the bush. And I cannot understand how the book of any "philosopher of science" could possibly trump evidence based medicine, whatever the fellow wrote. In my mind, the discoveries of science, history, economics, mathematics, etc. may be fodder for philosophers to mull over while attempting to create "larger" ideas from such components. But a philosopher setting himself against evidenced medicine would seem to be the tail wagging the dog.

It will be interesting to see how your exchange goes. And we haven't even gotten into microfascism yet. (In my mind, that term keeps creating images of tiny, goosestepping tin soldiers, their chins all raised arrogantly like Mussolini.)

[Edit: Atrocious spelling & typos.]


Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive.
Edited by - HalfMooner on 08/29/2006 23:44:10
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Dude
SFN Die Hard

USA
6891 Posts

Posted - 08/29/2006 :  23:02:12   [Permalink]  Show Profile Send Dude a Private Message
quote:
Objective The philosophical work of Deleuze and Guattari proves to be useful in showing how health sciences are colonised (territorialised) by an all-encompassing scientific research
paradigm – that of post-positivism – but also and foremost in showing the process by which a dominant ideology comes to exclude alternative forms of knowledge, therefore acting as a fascist structure.



There are so many obvious problems with this that I don't know where to begin.

If you extrapolate this thinking (albeit I may not be getting their full intent from the bit of the paper I read) then I guess you could say that those who accept the heliocentric model of the solar system have created a "fascist structure" that excludes those who prefer the terra-centric model?

I guess you could say that about any bit of evidenced science, that things with evidence to support them are favored to the exclusion of those things that don't have evidence to support them.

But is that a bad thing? I don't see how it could be.

Maybe their complaint is about stringent standards of evidence? But still, I can't see how it would be bad to require evidence that can withstand rigorous scrutiny.


Ignorance is preferable to error; and he is less remote from the truth who believes nothing, than he who believes what is wrong.
-- Thomas Jefferson

"god :: the last refuge of a man with no answers and no argument." - G. Carlin

Hope, n.
The handmaiden of desperation; the opiate of despair; the illegible signpost on the road to perdition. ~~ da filth
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Dude
SFN Die Hard

USA
6891 Posts

Posted - 08/29/2006 :  23:31:26   [Permalink]  Show Profile Send Dude a Private Message
Ok, just finished reading their whole paper.

Not one time did they provide a single example of these "other ways of knowing" of which they are apparently so fond, and think are the equal or better of an evidence based approach.

And their comparison of evidence based science to fascism is disingenuous at best. They devote almost a whole page to compare evidence based medicine to Orwell's "newspeak".


Ignorance is preferable to error; and he is less remote from the truth who believes nothing, than he who believes what is wrong.
-- Thomas Jefferson

"god :: the last refuge of a man with no answers and no argument." - G. Carlin

Hope, n.
The handmaiden of desperation; the opiate of despair; the illegible signpost on the road to perdition. ~~ da filth
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beskeptigal
SFN Die Hard

USA
3834 Posts

Posted - 08/30/2006 :  00:08:41   [Permalink]  Show Profile Send beskeptigal a Private Message
After the next reply if I get one, (and I think I will), I'll send them a link to this forum. Debate was their stated goal. I'd love to debate them here.
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HalfMooner
Dingaling

Philippines
15831 Posts

Posted - 08/30/2006 :  01:28:03   [Permalink]  Show Profile Send HalfMooner a Private Message
Bring 'em on, French philosophers and all! Philosophers: The other white meat.


Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive.
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McQ
Skeptic Friend

USA
258 Posts

Posted - 08/30/2006 :  14:14:16   [Permalink]  Show Profile Send McQ a Private Message
quote:
Originally posted by beskeptigal

After the next reply if I get one, (and I think I will), I'll send them a link to this forum. Debate was their stated goal. I'd love to debate them here.



Thanks for taking the time to do this!

Elvis didn't do no drugs!
--Penn Gillette
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wombatwal
New Member

Australia
20 Posts

Posted - 09/29/2006 :  03:43:59   [Permalink]  Show Profile Send wombatwal a Private Message
I am new to the forum and found this thread very interesting.
I am a nurse and sort of understand where they are coming from but I don't agree with them. Here in Australia Evidence Based Medicine is the only way to go.
I was very surprised at the paper, but they have a right to express and publish these views.
Has there been any further correspondence with these authors.
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beskeptigal
SFN Die Hard

USA
3834 Posts

Posted - 09/29/2006 :  10:30:25   [Permalink]  Show Profile Send beskeptigal a Private Message
The authors have not replied to my second email. Disappointing. I have noticed more now though, how often these randomized clinical trials are indeed referred to in the medical literature.

Just heard a good lecture on the status of Alzheimer's intervention research. Lots of associations can be found and in the past we might have assumed a little more cause and effect implications. The lecturer was very careful to point out they can't determine cause and effect until the next step, randomized clinical trials. If anything, I think this really fine tunes the science. It made the paper in the OP even more questionable.
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