Would you let Foucault or Derrida treat your cancer?

Martin Rundkvist has discovered a peculiar little paper. It’s titled “Deconstructing the evidence-based discourse in health sciences: truth, power and fascism”, and here’s part of the 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

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.

It’s a paper that objects to the hegemony of EBM. That’s “Evidence Based Medicine” to you and me. The authors also resent the reliance on RCT—Randomized Clinical Trials. This is so strange that I had to read the whole thing.

Yes, I actually did.

And, you know, there actually is a teeny-tiny germ of a worthwhile idea imbedded in it. It’s sloshing about in the midst of a lot of impenetrable jargon, misplaced complaints about reliance on that horrid bug-a-boo, “evidence,” and worst of all, utterly outrageous accusations of fascism and references to Hitler and Mussolini, and talk about terror and totalitarian violence. It’s a bit overblown, but here’s one interesting point:

Of course, we do not wish to deny the material and objective existence of the world [that’s a relief, since he had just finished complaining about the people who are wedded to ‘evidence’], but would suggest, rather, that our relation to the world and to others is always mediated, never direct or wholly transparent. Indeed, the sociocultural forms of this mediation would play a large part in the way the world appears as full of significance. Empirical facts alone are quantities that eclipse our qualitative and vital being-in-the-world. For example, how should a woman assign meaning to the diagnosis she just received that, genetically, she has a 40% probability of developing breast cancer in her lifetime? What will this number mean in real terms, when she is asked to evaluate the meaning of such personal risk in the context of her entire life, a life whose value and duration are themselves impossible factors in the equation?

That’s actually useful to think about. Unfortunately, the ultimate grand failing of this paper is that it doesn’t present much thought about the questions, and proposes absolutely nothing to complement or replace that ol’ Evidence Based Medicine…the only message I got out of it was that the authors felt like complaining about those mean doctors and granting agencies that demand evidence for treatments.

I must be one of those evidence-demanding fascists, because my first thoughts on reading his question were that 1) evaluating the meaning of one’s entire life is something that can be done without demanding the suspension of evidence-based prospective treatments, and 2) isn’t this exactly the kind of situation that other ol’ fascist, Stephen J. Gould, found himself in when he was diagnosed with mesothelioma? He describes the process he went through in The Median Isn’t the Message, and it seems to me that he found the honest answers to his problem in the evidence, the data, and the assistance of modern medical care.

That’s a more productive and useful attitude than complaints about modern medicine as tools of 20th century totalitarianism, which is all this paper has to offer. There certainly isn’t any discussion of any alternatives.


  1. Douglas says

    That article was so nutty are you sure it wasn’t a satire? There were some pretty good straight-faced deconstructionist/science satires that made it into print in the 80s. More of the same?

  2. says

    I would be inclined to suspect a Sokal-like hoax were it not for the sensible qualification “of course, we do not wish to deny the material and objective existence of the world”, which a parodist would not have included.

    By the way, it is Foucault, not Foucalt. As in the pendulum.

  3. goddogtired says

    Yep! Those guys and gals sure were, and still a few are, full of themselves – and maybe something else as well (and it ain’t no parfumary, neither). And then these science fellas, mostly full of philosophy just as corn-pone based, come round to get their smirks and smiles in, jabbing one another with their elbows and thinking how high-and-mighty theirselves are; just to show they can be just as low as anybody else.

    PZ – thanks for noting that something, as small a grain as it was, was in that overwritten mess. I do get sick sick sick of the scientist ego that inflates instantly when philosophy is the topic.

  4. T_U_T says

    Of course, we do not wish to deny the material and objective existence of the world, but…

    Yes, we see, this is exactly why the entire ‘article’ is one big tirade against this evil fascist evidence which
    is utterly totalitarian because it simply exists no matter whether you like it or not. Or, as po-mos say, it is not ‘pluralistic’.

    In short, ol’good demagogy classic of the “Im not racist, but [ tons of hate-speech ]”, “I do not deny global warming, but [ most pathetic denial ever ]” sort…

  5. Jason Spaceman says

    Oh gawd, some of the authors of that paper are from my alma mater! It’s times like this that I wish I went to Carleton instead of U of Ottawa.

  6. Alex Whiteside says

    “Of course, we do not wish to deny the material and objective existence of the world, but would suggest, rather, that our relation to the world and to others is always mediated, never direct or wholly transparent.”

    I think what they forget is that they’re free to suggest anything they like, but some evidence would be nice if they want it to be accepted. I mean, I can suggest it’s in they’re best interests to jump in a lake of scalding hot bovril, but I imagine they might want an adequate justification, and perhaps demonstration, of its safety.

  7. Caledonian says

    Oh, so we’re always mediated? The mediating things are part of the world as well, so obviously there must be additional mediating things that stand between us and them. And mediators for them, and mediators for them… why, it’s just like the transitional fossil problem. There’s mediators all the way down!

    How much delusion, how much incompetence, stupidity, and shoddy thought does it take to reach the conclusion that people do not have a direct relationship with reality? Anyone can erroneously assert a statement that is at odds with empirical truth, but it takes a special kind of blinkery to assert a self-contradictory statement, to deny logical truth.

  8. says

    From the Centre for Evidence-Based Medicine (http://www.cebm.net/ebm_is_isnt.asp)

    External clinical evidence can inform, but can never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision. Similarly, any external guideline must be integrated with individual clinical expertise in deciding whether and how it matches the patient’s clinical state, predicament, and preferences, and thus whether i t should be applied. Clinicians who fear top-down cook-books will find the advocates of evidence-based medicine joining them at the barricades.

    EBM proponents are explicitly NOT fascists. There may be individual practitioners who are exclusionary and elitist, but they would be like that even without EBM.

  9. says

    Ack. I just read the article. It’s even worse than PZ represented it.

    I almost feel a Hitler Zombie piece coming on, but the Undead One’s been around a bit more than I usually like to use him lately.

    Certainly, as the ScienceBlogs resident apologist for evidence-based medicine, I need to address this piece of crap. I now have blog fodder for tomorrow. Thanks PZ.

    I think.

  10. Caledonian says

    I should note that, when showing that a conclusion is invalid, we don’t need to offer an alternative. The invalidity is enough — discarding the method doesn’t require putting a new one in its place.

    That’s not what this paper manages to do, of course. It doesn’t even begin to do that. But if it did, it would not be obligated to offer another. The absence of knowledge is in itself an improvement over false knowledge.

  11. says

    …as the ScienceBlogs resident apologist for evidence-based medicine…

    Can I be the ScienceBlogs resident apologist for evidence-based everything?

  12. T_U_T says

    Q :Can I be the ScienceBlogs resident apologist for evidence-based everything?

    [po-mo simulation]
    A : Can’t. Till you
    – define definition
    – prove that proofs really *do* prove something
    – bring evidence that shows that evidence can show something at all
    Otherwise you are as dogmatic religious believer as the fundies, and an evil totalitarian fact-fascist too.
    [/po-mo simulation]

  13. Brent says

    I look forward to reading Orac’s more detailed response. Thanks PZ for this post.

    Unfortunately this type of anti-EBM is not uncommon in healthcare settings, although not typically this explicit or to this extreme. It is also not uncommon to see no reasonable alternative specifically offered, but the obvious alternative is to allow the clinician to decide what truth is. Of course the clinician will likely use some “evidence” from clinical experience or knowledge of biology, however this type of evidence is known to be subject to many biases, since humans tend to be less logical than we think we are and we over estimate what we know or what we can explain (this known bias in the way we humans try to “logically” figure out problems is a big part of the appeal of RCTs, since they can avoid some forms of bias). This unspoken alternative to EBM gives the clinician a good deal of power and is probably a major source of the negative feelings toward EBM. No one likes to have power taken away from them. The big question to ask is whether there are more systematic or scientific methods to judge the appropriateness and effectiveness of care other than just the judgment of a single primary care clinician or small group of clinicians. People is favor of EBM seem to believe that there are better methods (RCTs being just one type of method), while people who oppose EBM seem to think that most methods are not better than clinical judgment. I am definitely in the camp that believes that scientific approaches can and CLEARLY DO improve on the quality of care.

    A brief side note, EBM type of systems can be subject to biases of their own, but at least they have in place mechanisms to protect against bias. One particularly susceptible situation is that EBM systems tend to produce guidelines that are then disseminated to huge groups of clinicians. Therefore, if someone, some political group or some company is able to stack the deck in a guideline committee that produces a systematic review, then there is the potential for that nefarious group to create a very large bias. There have recently been several complaints that big pharma was trying to directly influence such guideline setting groups. Of course a person could use the “no true Scotsman” answer and say that such a bias is in fact by definition not EBM, because it is biased, but I don’t think that such rhetorical arguments are very useful. I think that the solution to this problem is to ensure that there is a rigorous and transparent EBM process, but this is easier said than done.

  14. Ian H Spedding says

    This must be a parody because it’s not very well written. I could understand most of it – sort of.

    The irony is to be savoured, though:

    Drawing on the work of the late French philosopher,
    Jacques Derrida, deconstruction is notoriously difficult to
    define because it is a practice, and not a fixed concept
    based on abstract ‘facts’ or ‘evidence’. For our purposes,
    we might say that it is the critical practice of exposing the foundations that underpin the apparent truth-value of a
    certain concept or idea, challenging the way that it
    appears to us as self-evidently or ‘naturally’ so.

    In other words, the idea is to expose the hidden assumptions that underlie our understanding and explanations of the world.

    And they explain this – make it all clear – using language that hardly anyone can understand.

    It seems to me that if any jargon is “outrageously exclusionary” and fascistic – whether micro or macro – it is that of this withered branch of the humanities.

    Of course, the good thing about this paper, like others in the field, is that it is self-defeating. Few will read it and even fewer will understand it.

    Which, in a way, is a pity because it could be useful, although perhaps not in the way the authors intended.

    Ploughing through it is a bit like negotiating one of those garden mazes like the one at Hampton Court, both frustrating and satisfying.

    Satisfying when you finally reach the middle. Frustrating when you find that, after all that effort, there’s not much there to see.

  15. Bruce Mason says

    As a long time reader, part-time scholar in knowledge and belief systems but virgin commenter I’m moved to comment because I think this post has generated a rather facile set of comments.

    Shoddy scholarship and ill-thought out rants can appear in any context and any abstract with word “microfascism” in it is highly unlikely to be worthy of being taken seriously.

    On the other hand, the question which the authors are badly abusing is an important one and one which most scientists whom I’ve worked with have sympathy with: what socio-cultural factors affect the science that is done? This is not just at the macro-level (i.e. what gets supported and why) but at the individual level. Every epistemological framework immediately excludes a whole range of possibilities. Indeed the success of an epistemological framework may indeed be based on its ability to throw out the bathwater and hang on to a fair amount of the baby – as it were.

    Now a vanishingly small number of scholars in the field of the sociology of scientific knowledge/medicine are working from a premise that is hostile to science as practised in “western societies” but most SSK scholars are more interested in shining a light in the hope that greater understanding of science as practised by living, breathing, encultured, humans may generate insights that will enrich us all – or at least get the author tenure.

    You know, the essential premise of post-modernism – if that isn’t an oxymoron – is that as thinking agents we deal with the world at the level of epistemology. As human beings, we understand the world through simile, analogy, metaphor, narrative and, sometimes, claymation. Last I checked, scientists are humans too and experience the world the same way as the rest of us.

    When you run an experiment, perform a measurement etc you do your best to control the variables so that your status as a human does not influence the result. The interesting question though is how it is that we create experiments, decide what to measure, and understand what those results mean. Essentially it’s a question of looking at the relationship between human being and science. I happen to think that these sort of questions are really interesting questions to ask.

    I also happen to think that a relatively small number of people don’t want them asked for fear of that the fundies, among others, will try to use them to ‘prove science wrong’. However, not asking questions because someone else with an agenda may try to twist the answers is, in my view, wrong-headed.

    That said, I do think the article – on brief perusal – is barking mad.

  16. Tony Jackson says

    Q: What is a ‘microfascist’?

    A: Something that’s a thousand times worse than a nanofascist.

  17. Scott Hatfield says


    You are entirely too kind to the authors of this tripe. Most unlike you, really. Yeah, yeah, science as practiced by humans has a social dimension that affects what ideas are taken seriously, and those which aren’t. That’s a trivial observation, but that’s about all ‘constructivist’ takes on scientific practice have managed to dredge up in three decades of hand-waving. Where’s Sokal when you need him?


  18. says

    Every field of study has its cranks, fruitbats, incompetents, and people with a nearly supernatural talent for missing the point. Consider the possibility that when philosophy buffs who actually understand Deleuze and Guattari see this essay, they do a facepalm every bit as emphatically as you do.

    (It will be interesting to see how much of Guattari’s work survives increases in our understanding of neurochemistry. He was big on the idea that schizophrenia is a function of capitalism.)

    It is perhaps unfair of me to think that the International Journal of Evidence-Based Healthcare (formerly JBI Reports, published by the Joanna Briggs Institute) feels just the tiniest bit dodgy. I can tell that “evidence-based” is being used as a code word there, but I can’t make out what it’s code for. The journal’s main page says:

    “The International Journal of Evidence-Based Healthcare is a fully refereed journal that publishes original scholarly work from the international Joanna Briggs Institute and Collaboration. The Institute aims to advance the international understanding and development of evidence-based practice in multidisciplinary healthcare, including nursing, midwifery, nutrition and dietetics, physiotherapy, occupational therapy, complimentary therapy, medical radiation and podiatry.”

    I believe that’s the basic list of medical practices you’re allowed to undertake without having a full-scale medical licence.

    Here’s a summary of another paper published by that journal, The JBI model of evidence-based healthcare, which introduces the concept of “non-research-based evidence”. It might be illuminating to see the full text.

  19. says

    One of my friends received a death sentence from her doctors last year. She was told that median survival time for someone with her condition was six months. Ever the math teacher, she said that meant half of the disease victims had to survive more than six months.

    Thirteen months later, she’s still alive, firmly established as an outlier for people with her form of cancer. She knew what the evidence suggested and she understood that she still had a chance to hang in there and to witness certain important milestones in her children’s lives. I don’t think, though, that she would argue her survival to date is a blow to evidence-based medicine. Rather, it was evidence-based medicine that gave her the tools to extend her days, now trickling down to the final few.

    I wonder what the authors of the paper will do when they get ill. Herbs? Reiki? Scientological auditing? At least those aren’t tainted by evidence.

  20. G. Tingey says

    Several points…

    1. This has been noted by Ophelia et. al. over at:
    look for the section headed: “It’s a Trick, Right?”

    2. Unfortunately, it is not thought to be a hoax – which is a pity.

    3. “Caledonian” said something very pertinent in my opinion, which was:
    BEGIN QUOTE::: Oh, so we’re always mediated? The mediating things are part of the world as well, so obviously there must be additional mediating things that stand between us and them. And mediators for them, and mediators for them… why, it’s just like the transitional fossil problem. There’s mediators all the way down!
    ENDQUOTE :::

    I wonder – this is a very old philosophical problem, and one which has caused an awful lot of grief, by giving aid and comfort to religious claptrap.
    It’s called “Plato’s Cave”.
    The idea that the world we see and live in is NOT real, but the shadow, or projection or simulacrum of a “higher reality”

    This persistent idea is what we are really fighting against, and it is very difficult to squash – as shown my its’ longevity, if nothing else.

  21. says

    It seems to me that this is, yet again, the old relativist idea that all “knowledge” is equal. A large problem with that is that, of course, evidence is required to prove that a claim to knowledge is knowledge. Now,if you can just get rid of that pesky evidence requirement, why prayer, or waving crystals, or activated water will all cure cancer….

  22. Tony Jackson says

    G. Tingey: yes indeed, and before Butterflies and Wheels the excellent Ben Goldacre was gleefully stomping on this silly article with his microfascist jackboots (http://www.badscience.net/?p=277).

    “The International Journal of Evidence-Based Healthcare” isn’t exactly well known. Even so, it’s apparently fully refereed – so what were the referees thinking? Maybe they were laughing so much they inadvertently ticked the wrong box. Unfortunately, there’s plenty more of this sort of rubbish out there. Evidently, the enemies of Science and clear thinking aren’t just on the political Right.

  23. Sammy says

    If you’re interested in further rantings of this nature, I recommend the book, “The Reenchantment of the World,” by Morris Berman, which I read as part of an epistemology class I attended years ago.

    From my vague recollections: Berman’s thesis is essentially that science has become divorced from philosophy, and has therefore lost its way. Not a terrible thing to say, but along the way he makes some pretty hefty assertions. For example: that alchemists were actually able to transmute lead into gold, that the modern day version of that feat is nuclear decay, and the fact that we have divorced the scientific aspects of alchemy (chemistry, physics, et cetera) from the philosophical is what has led us to the nuclear bomb.

    Good stuff.

  24. says

    Boy do I hope it’s just someone having fun—writing papers like this about modernist authors or po-mo angst or something is one thing (in fact, I’ve written several myself), but I barely believe po-mo stuff when it’s about subjective things, much less when its about the objective world.

  25. sparc says

    According to wikipedia “Deleuze suffered from a debilitating pulmonary ailment throughout the last 25 years of his life. In his last decade this condition grew more severe and was compounded by respiratory problems. By the last years of his life, simple tasks such as handwriting required laborious effort. In 1995, he committed suicide, throwing himself from the window of his apartment.”
    Thus, if medicine would have been more evidence based in those days it might have helped him

  26. says

    Caledonian: Andrea Nye notoriously claimed logic was sexist … maybe that’s what you had in mind …

    Brent: As I recall, the authors are nurses. I think there might be a bit of turf-war going on here. My mother (retired nurse) experienced pomo and pseudoscience amongst her at the end of her career (e.g. “therapeutic touch”) and she got the impression it was done in part to have some way to “make us different”.

    Teresa Nielsen Hayden: Many philosophers would regard D. & G. as cranks. (I would.) Banal and true (science and technology are done in social systems! yay!) or outrageously false.

    Sammy: Funny, I say that philosophy is divorced too much from philosophy also and come to the opposite conclusions. Wonder why that is … oh, yes, maybe because I actually understand some science. Alchemy isn’t popular amongst some pomos because some of it was so brazenly sexist. Of course, another branch dismisses genuine science for the same reason. (Sandra Harding)

  27. sparc says

    Why search for such articles in the literature? Please try the
    Postmodernism Generator ( http://www.elsewhere.org/pomo ).
    You may check the result with the Inauthentic Paper Detector at Indiana University (you have to google it because the link does not go through your spam filter). However, there is some rumor ( http://improbable.com/2006/07/22/inauthentic-paper-detector/ ) that the detector does not work properly. Still, one could test some ID text with the detector.

  28. says

    Many philosophers do indeed regard Deleuze and Guattari as cranks. I don’t (D anyway; G, not sure – definitely an odd bird though). That the authors of this mess use D/G jargon doesn’t mean Deleuze would approve. For example, far from buying into the myth of the cave, Deleuze says Platonism is his explicit target. (I don’t recommend his books for non-philosophers though.)

  29. says

    a program that robs us…of our meaningful place in the world

    Who wants to take bets this was written by a bunch of creationists?

  30. says

    Assistant profs trying to be trendy relate their writings to some recent big name in a desperate attempt to get a publication. The fact that the author(s) of this paper cite Deleuze, for example, doesn’t mean that Deleuze would have any use for its conclusions.

    By the way, does it ever occur to anybody that there is something slightly screwy about characterizing a whole intellectual movement on the basis of the silliest available examples? Would an anthology of mediocre biology papers say very much about the validity of biology?

  31. says

    Joseph j7uy5: Exactly right–the patient’s preferences are one of the three legs of evidence-based medicine (EBM), so I find the common assertion that it overrides the patient’s experience a clear indicator that the critic hasn’t read anything about EBM. I have also found that–except for the hard-core alties–many people who make that assertion will listen to an explanation of EBM and possibly reconsider their misconception.

    Teresa: without having seen the journal yet, I’m certainly not in a position to make any guesses about the content, but “evidence-based” may or may not be being used as a code word (although they’re not off to a good start by misspelling “complementary”).

    I believe that’s the basic list of medical practices you’re allowed to undertake without having a full-scale medical licence [multidisciplinary healthcare, including nursing, midwifery, nutrition and dietetics, physiotherapy, occupational therapy, complimentary therapy, medical radiation and podiatry].

    By itself, that doesn’t mean that they can’t be evidence-motivated–in many of those disciplines, there are practitioners who want to drive it in the direction of EB practice. That they don’t always know what that means can be remedied, because it’s simply a lack of understanding of the scientific method and how to apply it–and they fill up courses on learning how to understand and read the scientific literature. We call it “developing research literacy”, and there’s a big demand for it, both by individual practitioners and by larger organizations, such as those who accredit schools.

    I expect that in some disciplines, like massage (with which I’m most familiar), this impetus may well lead to a split between those practitioners who want to integrate with medical professions, those who want to work in spas and such places where they don’t have to bother learning about EBM, and the hard-core alties which will never accept it anyway on principle. So I would not assume that the list of disciplines mentioned rules it out by definition.

    The JBI model of evidence-based healthcare, which introduces the concept of “non-research-based evidence”. It might be illuminating to see the full text.

    Yes, I agree that’s curious, but not necessarily a red flag–it could mean that they take a “best evidence” approach, using the hierarchy of evidence, where RCT is strongest, and anecdotal evidence is weakest. In situations where evidence from an RCT is unavailable or even impossible, you go with the strongest evidence that you’re able to get, which in some cases may be only one case study. If by “non-research-based evidence” they mean that using whatever evidence is available, even if it’s only poor evidence, and adjusting your expectations and confidence in that evidence accordingly, then I don’t see any problem with that per se.

    If, on the other hand, they’re advocating throwing out the methods of research altogether, I agree with you that it’s dodgy and that they’re debasing the word “evidence” into meaninglessness. I’d have to read the actual article to tell what their approach is.

  32. Tony Jackson says

    Jim Harrison:
    “By the way, does it ever occur to anybody that there is something slightly screwy about characterizing a whole intellectual movement on the basis of the silliest available examples? Would an anthology of mediocre biology papers say very much about the validity of biology?”

    Unfortunately, much of this stuff is indeed very silly. But maybe I’m being unfair. Jim, could you give us some examples from this intelectual movement that you consider to be high-quality, and we shall see.

  33. Hal says

    Of course EBM is rigorously restrictive, even dictatorial. It has rules, and exists only because it does. Moreover, its practitioners subscribe to them and for the most part stay within them. Thinking and operating within the rules is actually fun, and the results of that discipline benefit everyone. Pointing out the rules is a waste of everyone’s time; complaining about them is a waste of deconstructionists’ time, since the same accusations feed directly back at them, and more tellingly.
    EBM rules enforce maximum democracy in describing relationships between phenomena and in communicating that understanding across cultures, languages, attitudes, personalities, mindsets, etc. Deconstructionist rules enforce minimum democracy in possession of a single quasithought, ulimately devolving to a privileged audience of one. Which is more fascistic?
    This article was just a lot of solipsistic science envy.

  34. David Harmon says

    The maze of mediation can be tamed with a single distinction:

    “The map is not the terrain.” In no wise does that mean that the terrain is invisible to us, only that our representations of it are of finite (and sometimes dubious) accuracy. The point of all those scientific theories is to represent and explain what we find around us. In the service of that goal, we’ve learned impressive ways to compensate for the limitations of our senses. We don’t claim to be perfect, but you know, by now we really shouldn’t have to justify our existence. Skipping the profanity: It works, folks!

  35. says

    Tony Jackson: I refer you to Barbara Herrnstein Smith’s book Scandalous Knowledge, which is an account of the war on the boogie man of postmodern ‘relativism.’

    Examples of books that are rather hard to dismiss with a wave of the arm and a dose of snark: Andrew Pickering, The Mangle of Practice; Latour and Woolgar, Laboratory Life; George Lakoff, Women, Fire, and Dangerous Things; Foucault, The Birth of the Clinic; Ian Hacking, The Social Construction of What? Shapin and Schaffer, Leviathan and the Air Pump. I’d also include the works of Peter Galison and Richard Lewontin. (Note that these authors disagree with one another in many ways, but my point is precisely that lumping attempts to understand the social context of science into an undifferentiated mass is absurd.)

  36. George says

    They could have made whatever points they were trying to make against this group by not throwing insults, but then again, by calling the Cochrane Group a buch of fascists, they managed to get people’s attention.

    I happen to like postmodernism when it stimulates people to think outside the box and question the status quo, but it can also quickly degenerate into cleverness for the sake of cleverness and knee-jerk oppostion to whomever is in power.

  37. Greco says

    although they’re not off to a good start by misspelling “complementary”

    Maybe “complimentary therapy” is telling the patient “Good job! You’re doing great! You’ll get better in no time!” in the hope it will do any good?

  38. Kagehi says

    I read something recently that fits nicely into this. Most “medical miracles” are a result of:

    1. Misdiagnosis.
    2. Misinformation.
    3. Mininterpretation.

    Number 1 is a result of the fact that, much like any complex machine, hundreds of different things can go wrong, all producing nearly identical symptoms. Even if you have blood tests, x-rays, etc., flaws in these things, or sudden, but temporary, shifts in the blood work and produce false results, which do not accurately present the true condition. Someone can go in for X, recover from Y, and be described as “miraculous” solely do to the failure to correctly identify the problem in the first place. In places with clear rules in place, this is less common. Why the @$@#$# could any sane person want to make it “more” common?

    Number 2 is a doctor failing. Its easier in the minds of some doctors to give you the bad news that 50% of people die in X time, even when all available information would suggest that you are going to live significantly longer than that. Same with other even more serious, immediate life and death, situations. Its better, they feel, to imply a negative outcome, so no false hope developes, than say you will get better, only to be completely wrong. Worse, half the idiots they give good news to might sue them for telling them their friend/relative will live, then having them die. The irony being, such a negative view might, in some cases, increase the odds of them failing to recover, at the gain of covering the doctors ass. This of course leads to, “The doctors said he would be dead, but he lived!”

    Finally, the last is just ignorance of the patient or family, such as with coma victims. Such people “wake up” on a daily basis, the fact that doctors, as of yet, have no way to predict “when” this will happen makes every fool with someone in that condition calling, “miracle!”, when a *real* miracle would have been them waking up and not having a) motor problems, b) mental problems or c) drooling on the floor. The fact that, pretty much universally, save for more minor injuries, none of these people wake up without at “minimum” some serious memory loss, is glossed over.

    The only reason we “need” clinitian imput, over purely empirical, is that human bias exists, in the collection, analysis and diagnosis, and will likely continue to do so until we can toss someone on a bio-bed, a la Star Trek, and let the computer do 90% of the diagnosis. This means that only human intervention can “correct” the errors made when any of those processes fail. If this is the authors point then its stating the bloody obvious, if its not, then one can only assume they want to go back to the sort of crackpot days when phrenology and the reading of pigs entrails led to “diagnosis” of medical conditions and where the treatment, in circumstances where sufficient certainty is not available, reverts to shaman invoking animal spirits and puffing smoke in the patients face to drive out evil. (Or at least something that is, for all practical application, as equally useless.)

  39. says

    Apologies if you’ve already had this cited; I’ve got about a dozen tabs open … ButterfliesAndWheels.com in one set, The Philosphers’ Magazine Online in another … an embarassment of riches!

    I think this is sychronous: I just came across ““Deconstructing the evidence-based discourse in health sciences: truth, power and fascism” (“Some of you might enjoy this absolute cracker from the current edition of the International Journal of Evidence-Based Healthcare”)

    thanks for being here … tempting to think the world’s entirely mad, sometimes

  40. Ken Camargo says

    I don’t think Foucault, for one, would want anyone to ask medical advice from him… The paper PZ cites is in all probability a piece of crap (I haven’t read it but I trust his summary), but as Jim Harrison wrote above, it shouldn’t be construed as a paradigmatic example of a body of critical work that can be easily discarded (as shouldn’t Sokal’s prank, btw).
    For instance, consider the issue of clinical trials. They are no doubt one of the most important tools for assessing different therapeutic options. But that’s far from being the whole picture. Just take a look, again as an example, at what the former editor (for almost a quarter of a century) of the BMJ has to say:

  41. Torbjörn Larsson says

    This thread was of better quality than the paper.

    I believe Joseph’s and RavenT’s concerns touches the tacit knowledge that all areas have, even science. I’m reminded of working with experiments in vacuum, where there is a lot of this going into the design of the equipments and the experiments and the procedures of experiment and analysis. It isn’t all textbook knowledge, but it is of course in the end justified by repeatable experiments.

    The author’s idea of redefining the political term fascism to a social term microfascism (“polymorphous intolerances”) devalues it completely. (Ie, by more than a factor thousand. :-)

    “There’s mediators all the way down!”

    Apt. Perhaps they should have used ‘micromediators’ to dilute that effect.

    “Pointing out the rules is a waste of everyone’s time; complaining about them is a waste of deconstructionists’ time, since the same accusations feed directly back at them, and more tellingly.”

    I thought so too:

    SteveC:s link on deconstruction says “Buried in the muck, however, are a set of important and interesting ideas: that in reading a work it is illuminating to consider the contrast between what is said and what is not said, between what is explicit and what is assumed, and that popular notions of truth and value depend to a disturbingly high degree on the reader’s credulity and willingness to accept the text’s own claims as to its validity.”

    But it also describes deconstruction as a contrived method to read a text to find two different interpretations of what the text describes or models. “In particular, find a way to read it as a statement which contradicts or undermines either the original reading or the ordering of the hierarchical opposition (which amounts to the same thing)”.

    So it is a general critique of models and their problems. But in effect, following the steps sketched, it resorts to demonstrate the problems specifically each time by using a text in a poorly defined manner to find models, not once, but twice!

    “Deconstruction is an idea that would make a worthy topic for some bright graduate student’s Ph.D. dissertation but has instead spawned an entire subfield. Ideas that would merit a good solid evening or afternoon of argument and debate and perhaps a paper or two instead become the focus of entire careers.”

    It seems easy to agree with that conclusion.

  42. Torbjörn Larsson says

    “This thread was of better quality than the paper.”

    On second thought, I apologise to everyone in this thread since indeed the paper, apart from some concerns for tacit knowledge and the problem of diagnoses, is crap.

  43. idlemind says

    …as the ScienceBlogs resident apologist for evidence-based medicine…

    Can I be the ScienceBlogs resident apologist for evidence-based everything?

    One would hope that would be a requirement for anyone on ScienceBlogs. Wouldn’t “evidence-based” be a prerequisite for all things scientific?

  44. zfred@hotmail.com says

    Sounds like a lot of Troll’s Truisms, as defined by Shackel in his Metaphilosophy paper:

    “A Troll’s Truism is a mildly ambiguous statement by which an exciting falsehood may trade on a trivial truth. A typical example of a Troll’s Truism is the statement that anything constructed could be constructed differently. This particular truism I think of as being, for postmodernists, the ur-truism from the ur-troll. On this postmodernists have built what they have taken to be a radical critique of rationality. The exciting falsehoods that can trade here are the notions that what we know, what the truth is, and how the world is, are constructed by us and so arbitrary: the trivial truths merely that we construct our beliefs, we construct meaning and act on the world on the basis of our beliefs. Prescinding from the question of truth bearers, obviously, which statements are true depends on what the sentence used in an utterance means, which in turn depends on how we have constructed meaning. As postmodernists have proved, there is plenty of room for manipulating meaning tendentiously, but we are not thereby manipulating the world. There also comes the point at which having constructed a meaning differently we have no longer constructed the same thing. Of course, we can use the same word, but we are no longer speaking of the same thing. We shall see an example of this shortly.

    “When used thus to assert social constructivism the truism insinuates the notion that there is no objectivity without ever arguing for it, yet permits a retreat to the trivial truth whenever pressed by an opponent on the exciting falsehood. A beautiful example of this is Stanley Fish’s defence to the exposure of postmodernist nonsense in the Sokal affair. In his paper Sokal asserted explicitly a number of standard doctrines of postmodernism. Social constructivism denies that there is “an external world, whose properties are independent of any human being and indeed of humanity as a whole” (Sokal 1996). In the book “The Sokal Hoax” Stanley Fish performs the retreat to the trivial truth as follows
    “What sociologists of science say is that of course the world is real and independent of our observations but that accounts of the world are produced by observers and are therefore relative to their capacities, education, training, etc. It is not the world or its properties but the vocabularies in whose terms we know them that are socially constructed – fashioned by human beings – which is why our understanding of those properties is continually changing. (Fish 1996)””

  45. says

    p.s. I just got a few minutes to focus and managed to catch “but would suggest, rather, that our relation to the world and to others is always mediated, never direct or wholly transparent. Indeed, the sociocultural forms of this mediation would play a large part in the way the world appears as full of significance. Empirical facts alone are quantities that eclipse our qualitative and vital being-in-the-world.”

    You’re very kind in noting this … sweet of you, actually. It strikes me as poingnant, how such an appreciation of our experiences here has yet to become operative. Basically we’re still bashing ourselves over the hand with what ever object comes to hand.

    In the mid-70s I was giving presentations and conducting workshops on social justice … “dev-ed”, doncha know, Paolo Freire and all that. The thick-headedness of the nice people who attended never failed to throw me for a loop. I withdrew to the hills and raised a family of five … fortunately C=64 came along, and Mandelbrot, so I had something like a passtime.

    More recently, after reading John Willinsky on scholarly publishing, I’ve come back to the nut of things … “negotiated truth”; does that offend? If we’re on a life-boat and one fellow argues with conviction that everyone else should commit suicide so that he has enough food to survive, I think we could negotiate his fate easily enough … concensus isn’t all that rare or hard to come by. I mean, we wouldn’t have to throw him overboard. Or, at least, not immediately. Of course that would remain a reasonable option. Anyhow, I’m angling towards “Participatory Deliberation” … while applying discourse ethics and appreciating subjective narrative til we gag, it always remains an option to utter “I refute you thusly!” and give the concensual rock a good kick.

    We aren’t angling towards absolute certainty, are we? Oh my, that would be sad … you know, “perfectionism is the enemy of the good”. Perhaps we might be more mindful of being (actually and in fact) a community … like it or not … space-ship earth yada-bla-blah. It’s an option.


  46. goddogit says

    Why all the bile in the post-modernism threads? It isn’t even like some carnival act posting, some “Hit the Bozo with the Baseball.” The anger and viciousness in these threads is MUCH deeper, and very akin to something that might be on UD, frankly.
    A lot of the posters above seem far more afraid than dismissive. They force me to remember that, for all the emphasis on “evidence” there really is a cultishness, a sticky, unpleasant – but very, very human – residue in the best of “science.”

    Anyway, go to it and embarress yourselves thoroughly. I certainly need to be reminded that everyone on every side in every debate is a human being (Twian definition).

  47. Mike Rogers says

    “Of course, we do not wish to deny the material and objective existence of the world, but would suggest, rather, that our relation to the world and to others is always mediated, never direct or wholly transparent.”

    So how does this argue against our general dependence on evidence? Unless you think we cannot obtain *any* usefult information about reality from evidence – in which case why even bother to make this argument – this statement just impes that we always need good critical analysis of evidence on the presupposition that evidence is telling us something about the world. Isn’t that what science is all about? What am I missing? Do they truly believe that, steeped as we all are in the ideas of relativity, quantum mechanics and neuroscience, we are so naive as to be unaware that our experience is always mediated?

    This has to be a joke.

  48. says

    Forgive me for going on and on and on … but really, the synchronicity is awesome. John Dean is on TV saying the has discovered the body of studies that has since WWII shown how conservatives’ “mean streak” leads to authoritarianism. “Conservatives Without Conscience”.

    Gee … I realized that in ’73, when I abandoned my military career (communications intelligence). And I was 19 at the time. My thesis is that class (i.e. status / rank / position on the ladder) necessarily conditions consciousness; post-modernist clap-trap helps well educated yuppies’ carry on with the work of erecting Global Gulag. But now I’m ranting, so I’ll just stop.

  49. says

    What am I missing? Do they truly believe that, steeped as we all are in the ideas of relativity, quantum mechanics and neuroscience, we are so naive as to be unaware that our experience is always mediated?

    I think a couple of things are going on to varying degrees.

    Confirmation bias is one of them–clearly, some clinicians have been jerks when it comes to the patient’s experience and these instances get magnified in anecdote and memory, while the sympathetic clinicians don’t get remembered in the same way. For example, when the orthopedist of one of my patients told him “massage won’t do anything for you; it will only make you feel better”, that one guy’s insensitivity to how much simply feeling better can mean became a recurring joke between the patient and me. So if I were someone who were inclined to believe that MDs (or just all orthopods) were all like that, I’d tend to remember that, and tend to forget how when Mr. Raven broke his upper arm, and rotated half of it out of the joint, his orthopedist was extremely solicitous and caring, and went more than the extra mile in taking care of him.

    The practice of medicine has changed, too–EBM hasn’t always been the norm, and in fact there was a time when a paternalistic doctor-patient relationship was strongly reinforced, with the corresponding de-emphasis on the patient’s autonomy and phenomenology. A lot of the pushback to that model is, I think, appropriate revulsion at what was pushed as the norm in the ’50s, but it seems to be without recognition of some important facts. One is that that model has been being revisited since at least the 60s, with the movements toward patient self-care and autonomy in decision-making (the breast and prostate cancer movements, the AIDS advocates, etc.), and that these movements have resulted in social change in the practice of medicine.

    A second fact that I think gets overlooked a lot is that while these movements have been driven by patient advocates, they’ve always been supported by a great number of individual doctors and nurses, if not the major physician organizations. So a lot of the practitioners have, as well, been instrumental in deconstructing the previous paternalism in medical practice, a fact which I don’t think they get enough credit for. After all, the AMA, even with its rep for aggressively defending the power and influence of physicians, can boast less than half of American physicians as members. Again, though, confirmation bias plus this ignorance of contemporary history and sociology, reinforces the perceptions of the bad ones and buries those of the good. While it isn’t perfect yet by a long shot, it’s come a long way since the height (or, perhaps, nadir) of the caricature of the relationship they’re reacting to.

    Failure to distinguish between imperfect correlation and randomness is another problem–perhaps we can’t perceive and measure the material world perfectly, as a result of the way our senses operate, but that doesn’t mean that our perceptions have *no* correlation to the material world. Some people seem to operate in a binary mode–either everything’s perfect, or else, all bets are off. Nothing in between.

    There are probably tons of other cognitive biases going on in addition, but those are the ones that I keep running across the most in people who don’t know much about science, but who are motivated to begin learning as adults.

  50. says

    Just on the ‘mediation’ issue– the claim is not about intervening entities or processes, it’s about the ‘taking up’ of sensory ‘data’ into a language (which always brings some theoretical commitments with it), in which our observation claims are expressed. Of course the apparent assumption that such commitments are untestable, and that no form of authority can be justified or legitimate, is absurd. We have perfectly good standards, reflected in EBM, which have their roots in simple common sense, not in a ‘microfacist’ imposition serving the interests of some privileged elite. (It’s worth noting here that alternative treatments have generally thrived in areas where EBM has not had great or complete success– though there is also a lunatic fringe who reject it even where it works well, including Jehovah’s witnesses attitude towards blood transfusions.)

  51. Torbjörn Larsson says

    “(Ie, by more than a factor thousand. :-)”

    Duh! By more than a factor million.

    “A Troll’s Truism is a mildly ambiguous statement by which an exciting falsehood may trade on a trivial truth.”

    Those damned trolls!

    “A typical example of a Troll’s Truism is the statement that anything constructed could be constructed differently.”

    I find that an illuminative discussion.

    “Do they truly believe that, steeped as we all are in the ideas of relativity, quantum mechanics and neuroscience, we are so naive as to be unaware that our experience is always mediated?”

    I think they don’t get that mediation is taken care of by our models.

  52. Timothy Scriven says

    I think there is a paradox here. The people who are defending the paper are mostly doing so at the cost of suggesting it says something ( and the something varies from defender to defender) fairly trivial, something that every scientist, philosopher and properly educated layman already knows about anyway. The papers defender’s are hence doing as much harm to it as its detractors. I think we should take the authors at their word and assume they really do mean what they say in a literal interpretation of their paper.

    Postmodernism isn’t just the trivial thesis that we have biases, or that we do not perceive things directly ( facts philosophers and thinking people have been pretty much always aware of), its more than that. It implies if not a quite absolute skepticism about knowledge and truth something pretty close, if its skepticism about metanarratives is lessened its hard to prevent it from becoming trivial. As an analytic philosopher I’d be really interested to see the details of how a belief in evidence based medicine and its methods can be consistent with postmodernism, I just can’t imagine how you could reconcile them.

  53. says

    Last time I checked there was no Postmodernist International so there is no official Postmodern position and the word postmodern has little use except as a scarecrow. So who’s supposed to be corrupting the youth this time? We hope the culprits are more alarming than a couple of assistant professors, but the defenders of the Faith persist in getting excited about nonentites.

    Just as uranium eventually becomes lead, every European intellectual movement brought to America eventually decays into a vague sort of cultural relativism. But why should anybody care about this dreck is a mystery to me–one would think that the challenge is to respond to serious representatives of alien ideas rather than to middlebrow popularizers.

  54. Rey Fox says

    Can I be the ScienceBlogs resident apologist for evidence-based everything?

    Why should you have to apologize for that?

  55. Tomas Skov Lauridsen says

    What people here fail to realise it the play-of-difference that the neo-metanarative of the article constructs. It is in the body-as-machine and man-as-machine dialectic. The metameaning of the sublime bodies-as-objects-of-punishment and the discourses of the intransive aspect of medicin-as-science/medicin-as-culture narrative or even postnarrative, disciplins the counter-imagination of the taken-for-grantedness of organless-bodies.

    For further illumination read this article: http://www.elsewhere.org/pomo

  56. Dee says

    It did look like a Sokal-type hoax at first.

    But yeah, that qualifier is a cri-de-coeur more than a few who’ve been diagnosed/had a loved one diagnosed with a serious illness could idenitify with.

    I am a believer in scientific method as the best, or at least, most workable paradigm. But the elevation of the life sciences (esp. Genetics) to almost God-like status is ridiculous. Your genes may be necessary for your existence, but saying they predict all future outcomes is like saying the twenty-six letters of the alphabet inevitably lead to, among much else, Hamlet.

    Bowlderization of genetic knowledge by the media has resulted in corporations and other employers demanding the right to assess putative and existing employees’ genetic propensity for disease.

    Now that’s real Fascism.

  57. Dee says

    Another point. The writers might be taken more seriously if, instead of bashing EBM, they raised questions about it’s efficacy and how (and where) it is applied.

    The WHO has declared depression THE 21st Century disease empidemic.

    But…is it a disease? Or a perfectly rational response to emotional isolation/abuse/psychosexual brutalism? (The suicide rate among female porn-stars in the U.S. for example, is three times the national average. Or was three years ago when someone bothered to check.)

    Finding neuro-correlates to the condition does not prove organic causes. That hasn’t deterred the pharma co.s producing psychotropic drugs mimicking SSRIs to ‘combat’ depression. It’s a highly lucrative market, so what’s to stop them?

    EBM is at its most vulnerable/questionable in the area of psychiatry, because it uses ‘normative’ indices of behaviour to assess normality. If it was confined to identifying ACTUAL brain lesions/hormonal disturbance, then medicine could pull back and leave the depression epidemic to be solved by everyone putting on their thinking caps: why are we experiencing isolation? Why so many? Does the answer, dare I say, lie in social/political/economic conditions?

    Why, in short, are we so stressed?

  58. Tony Jackson says

    Jim Henderson: “But why should anybody care about this dreck is a mystery to me–one would think that the challenge is to respond to serious representatives of alien ideas rather than to middlebrow popularizers.”

    Yes, but these middlebrow popularizers often teach at Universities, sit on hiring and PhD committees etc. Dave Holmes apparently teaches the next generation of nurses, but on the basis of his published articles he must be filling their heads with goo.

    Ps: thanks for the suggested good quality examples. I read Leviathan and the Air Pump when it first came out and enjoyed it even if I didn’t agree with the premise. Lewontin writes interesting stuff too – made more credible by the fact that he is a practicing scientist and knows what he’s talking about. But Bruno Latour? His mastery of fundamental scientific concepts is, to put it mildly, rather limited. Eg:


  59. Caledonian says

    Yes, Dee, psychiatry is an “art” and not a science, and it shows no signs of becoming a science any time soon.

    Unfortunately, there are lots and lots of people who desperately want the validation and social authority that comes with science — and so they will steal science’s mantle to put it around the shoulders of their favorite explanations.

  60. says

    Dave M: I certainly agree that they might not approve. But if one writes so unclearly and pretentiously that people can distort one repeatedly along these lines (and this interpretation is nothing new), then something is wrong in one’s own house. I believe it was the sociologist of science Stephen Cole (and maybe philosopher Susan Haack) that pointed out that ilk do say all sorts of sensible, perhaps even important things which they often point out when they are called out. What is also true is that they also say outrageous things as well.

    Jim Harrison: The problem is that for a while a lot of these fashionable French guys (and a few others) were all the rage, particularly amongst English professors who got bored with Shakespeare and Austen and moved to “cultural studies.” Not all cultural studies is bad, of course, though I do find a lot of it seriously banal, too. Of course, they suffer from lack of proper scientific training and run into problems that way, but also the adoptions (as if representative of the profession!) of these popular French thinkers is even more silly, and a little sad. I’ve yet to figure out exactly their influence in France itself. Jacques Bouveresse, a very sensible French philosopher, seems to imply that they were and are sort of “media stars” there and that the departments were sort of divided on the merits. Incidentally, I have read that towards the end of his life, Foucault gave up obscurantism, just like Feyerabend. Funny how being terminally ill can do that.

    (responding to JH’s next message) It is true, however, that there are degrees of merit and different sorts of errors. But I cannot believe that you actually put in Latour as an example of a sensible case …

    Torbjörn Larsson et al: Deconstruction seems to assert that one can read a text in arbitrarily many ways and that one is literally trapped in language. I’ll ignore the second claim and let anyone who wants to seriously consider it to check herself into a psychiatric ward. The first claims seems to be supported by the fact that sometimes texts are ambiguous. Unfortunately for Derrida (or his followers) ambiguity is usually quite restricted, amazingly. For example, nobody can take my reply and take it as a recipe for sausage and pepper pizzas. Another interesting twist to this is that Derrida also makes some of his claims of “language play” in ways that aren’t translatable. (“writing”, “screen” and “coffin” don’t even sound alike in, say, English.) This would be acceptable in poetry or the like, but if one is making a serious factual claim, making sure one isn’t making use of an ideosyncratic feature of one language is a good idea. I note that Derrida is not the only one guilty of this error (rather than foolishness, in this case). Donald Davidson is, too. His famed argument in favour of the metaphysical postulation of events relies on a feature of what could be just English. (He has since been vindicated in very different languages, but he should have been more cautious at the time. See my MA thesis on my website for more about this.) Philosophers of all stripes have a notorious habit of treating language as the alpha and omega of all concern …

    Timothy Scriven: To bring up Donald Davidson again, he has long advocated a principle of charity, by which you try to maximize the truth value of what someone is saying in order to give them the best break possible. I do try to do that. But I also adopt Popper’s principle of charity, which is that one should treat the propositions of one’s interlocutors as being important enough to be worth being refuted. (There is one philosopher of sorts who I have mentioned in passing several times on this blog who I usually regard as not worth the time, so this is a distinction.) My friend Raven (not the one here) told me that this was a wonderful thing to do for someone. I’d like to think it is, but so many people think criticism of ideas is criticism of people. (Part of the reason for my ignoring the philosopher of sorts mentioned above is that his philosophy and his nastiness as a person were so intertwined that getting involved in all of that seems to “rub off”.)

  61. says

    This thread has gone on long enough. A couple of parting (Parthian?) shots:

    1. My list of “serious” recent books on the sociology/philosophy of science is an endorsement of their relevance rather than their truth. Indeed, you couldn’t agree them all since they disagree with each other.

    2. The trouble with the “know your enemy” school of intellectual history is that it amounts to a form of stereotyping. If you want to score rhetorical points in order to deny the legitimacy of criticism of your point of view, it makes sense to single out the worst possible cases and imply that they are like all the others. If you’re trying to understand something, how science works as a social institution, for example, you don’t care very much about the crap you have to ignore, since you aren’t looking for the crap. Thus, for example, Bruno Latour’s failings as a physicist are less interesting to me than his ethnographic redescriptions of what goes on in a lab or the meditation in his Pasteur book on the meaning of the great man in the history of science. (By the way, if we’re really going to judge thinkers by their errors, don’t we need a baseline measurement of the normal rate of stupid remarks in serious books? And do the many ignorant remarks that scientists make about philosophical matters mean that we should dismiss their scientific arguments? If philosophical stupidites don’t count, but scientific stupidities do, does that imply that what’s really involved here is a turf war between disciplines?)

    3. If you’re going to use the word “deconstruction,” it would help if you know what it meants. Granted that “deconstruction,” like “democracy,” has been largely drained of determinate meaning in popular writing, it once had such a meaning. In the early writings of Derrida, it was an extremely specific notion related to other philosophical methodologies such as Cartesian doubt and what Edmund Husserl called “bracketing.” It certainly wasn’t “anything goes.”

  62. Kagehi says

    Lets deconstruct the deconstructionists (whould be called constructionists really, given the elaborate lengths they go to in order to invent an ediface of words that say basically nothing), and simplify the entire concept to its purists form:

    1. Telling someone 2+2=4 is fascist, since it forces an “assumption” on them.
    2. 2+2=4 can be true and non-facist *if* you instead show that taking two pairs of two objects will give you 4 of them.

    This is what drives me nuts about these people. Eithere their actual point is so insanely trivial that it could have been stated in one sentence, but takes up “pages”, or they form elaborate gibberish that has no valid purpose other than to attempt to redefine who can be considered an authority on the subject, without usually doing a damn thing to refute the methods, processes or concepts themselves, uless that is the point, in which case they just go to rediculous lengths to obfuscate the fact that the end result is the same set of methods, processes or concepts they just spent pages complaining about. Its like listening to a linguistics expert argue that no one should be credited with inventing the toothpick, solely because of the trivial fact that people had used sticks to pick stuff from between their teeth long “before” someone “invented” a more effective, mass produced, device for doing so. No, come to think of it, most of the time the argument is even stupider than that and far more devoid of any valid point.

  63. Tulse says

    I do think that it is rather unacademic to dismiss this paper out of hand — there is a long history of medicine being used for various social or political ends (e.g., the institutionalization of “hysterical” women, or the pathologizing of homosexuality). So I don’t think there is much to be gained in trying to deny that history.

    It seems to me, however, that the arguments can be attacked more fruitfully on their own ground. For example, as RavenT points out, EBM helped to democratize medicine by undercutting the paternalism (and personal biases) of individual physicians — today anyone can go online and find out what the consensus best treatment is for a disorder, and demand it of their doctor. This fact has greatly shifted the power in the healthcare relationship to the individual.

    Further, because the authors fail to provide any concrete examples of alternatives to EBM, they don’t make a case that any other approach would be less fascist. If we agree that all knowledge is mediated, and all relationships involve power, it’s not sufficient to say that EBM has these qualities. Frankly, I think it is far more fascist to convince someone to damage their health by taking an ineffective medication than it is to present the individual with evidence based on large studies. It’s noteworthy that, for all their complaining, the authors don’t give us any type of medical research of which they do approve.

  64. Tony Jackson says

    Jim: “My list of “serious” recent books on the sociology/philosophy of science is an endorsement of their relevance rather than their truth. Indeed, you couldn’t agree them all since they disagree with each other”.

    But unfortunately, in all too many cases the issue is not primarily whether one agrees or disagrees with a writer, but whether or not one can figure out what the hell they’re saying. As I noted, I like and respect Lewontin but find Latour fatuous. Part of the reason is that Lewontin’s meaning can generally be understood (making it easy to agree or disagree with him), but Latour et al., are often just opaque. Sokal’s point is critical here: Latour claims to provide novel insights into the way Science is conducted, but Latour has a grotesquely screwed-up understanding of even the most basic of scientific concepts. That, plus his impenetrable prose makes me think that I’m wasting my time.

    In a review of Sokal and Bricmont’s critical book on Postmodern thinkers, Richard Dawkins quoted Peter Medewar:

    “Style has become an object of first importance, and what a style it is! For me it has a prancing, high-stepping quality, full of self-importance; elevated indeed, but in the balletic manner, and stopping from time to time in studied attitudes, as if awaiting an outburst of applause. It has had a deplorable influence on the quality of modern thought”.


    Now come on, you have to admit that Medwar has a point here! We Scientists are busy, we have grants and papers to write, experiments to do, Grad students to look after and courses to teach. I’m afraid the temptation is just to let the asses bray.

  65. Torbjörn Larsson says

    Whether clinical depression is a rational or evolutionary response to stress, it is both a disease and a diagnosis: “A disease is an abnormal condition of the body or mind that causes discomfort, dysfunction, or distress to the person afflicted or those in contact with the person.” ( http://en.wikipedia.org/wiki/Disease )

    If one has been in close contact with sufferers one has a hard time doubting that. It is also like drug addictions: it has a heritable component, it is triggered by stress, it modifies the brain, it is hard to avoid recurrence, and antidepression medicines helps some drug addicts.

    Thanks for the short definition. I believe I understand the meaning after reading the ‘Deconstruction for Dummies’ walkthrough that SteveC linked to.

  66. Torbjörn Larsson says


    Interesting term, but I can’t find clinical depression under it.

    Apparently it’s called a disorder in english:
    “clinical depression is a medical diagnosis … The diagnostic category major depressive disorder appears in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. ” ( http://en.wikipedia.org/wiki/Clinical_depression )

    Which refers back to disease:
    “Disorder may refer to : * a medical disease”
    ( http://en.wikipedia.org/wiki/Disorder )

  67. Caledonian says

    I fear that has more to do with sociopolitical sophistry than science, Mr. Larsson. But mental disorders, with only occasional exceptions, are syndromes.

    The most common explanations for them, the ones given in public, are not only wrong but widely known to be wrong, and have been for decades.

  68. Jeremy says

    I have a soft spot for pomo and deconstruction. I think its generally too easy for scientists and rationalists to snipe. And knowledge, knowledge that underpins action, gets marshaled in complicated ways. Much of what passes for reason turns out to be retrospective rationalization and the positivists stopped convincing me a long time ago.

    My own training (heavily laden as it was with math modeling and evolutionary and molecular biology) give me an interesting distance from the compact mathematical laws of nature that seem to inspire physicists and the postivism that flows from physics. (I now work in biotech/pharma.)

    I don’t particularly like the phrase “evidence based medicine” since like other carefully chosen movement names (e.g. “the biological species concept” or “pro-life”) it manages to slap the opposition (evidence lacking, abiological, pro-death) as soon as you accept and use the name. Much other medicine uses evidence and much that isn’t medicine uses evidence.

    Does the rise of EBM really mean (as the authors of the Deconstructing the … contend) that it has become equivalent to the truth? What would that even mean? Doctors often operate outside the domain of well established clinical trials (must do, there just aren’t studies or patients for every combination of factors). So EBM would never operate without bridge principles that allow you to move from the clinical result to the immediacy and contingency of a patient.

    The paper’s claim that voices are being stymied by conventionalism requires more (ouch) evidence for me. I also don’t quite see the utility of the notion of micro-fascism. What fascism can give you is a target for agitation (or a justification for almost anything e.g. George Bush’s use of the term). To assert that not thinking outside the box makes the box micro-fascistic seems overblown and won’t really help people look up and notice the birds flying by…

    The authors like the word “ossifying.” I do too, but some of their pomo tools have been around longer than the EBM movement. So you gotta be careful who you accuse of being a fossil.

    I am a long time fan of Feyerabend and as such am convinced that rather than stand with, he would eviscerate Holmes et al. And I actually think they aren’t doing pomo criticism many favors with this screed. I kept wondering, if they have noticed that we are missing something important why not just tell us.

  69. Timothy Scriven says

    “and the positivists stopped convincing me a long time ago.”

    Wouldn’t it be wonderful if we could clarify the meaning of this word.

  70. Torbjörn Larsson says

    “I fear that has more to do with sociopolitical sophistry than science, Mr. Larsson. But mental disorders, with only occasional exceptions, are syndromes.”

    English is certainly not my primary language, nor am I versed in medicine or sociopolitical sophistry. I can only go with the information at hand, which is the DSM and ICD systems and the wiki.

    All of which call them disorders, ie diseases, and says of syndromes: “It is most often used when the reason that the features occur together (the pathophysiology of the syndrome) has not yet been discovered.”

    ICD-10 is online and lists some diagnostics as syndromes: “(F50-F59) Behavioural syndromes associated with physiological disturbances and physical factors.” This list does not contain the mood disorders under which the MDD equivalent is listed.

  71. Caledonian says

    Um, ‘disorder’ does not imply that a thing is a disease. It only implies that a thing does not fall into the expected pattern and that this deviation is considered a negative one.

  72. says

    Complimentary therapy, as practiced by Dr. Von Zimmer:

    “Ah, Matisse, what a lovely dog you are …
    such a pretty dog.
    And such pretty eyes you have.
    What a lovely dog. ”

    Don’t you feel better already?

  73. Torbjörn Larsson says

    “Um, ‘disorder’ does not imply that a thing is a disease. It only implies that a thing does not fall into the expected pattern and that this deviation is considered a negative one.”


    BTW, the dictionary definition is wider than wikipedia:
    “disorder – condition in which there is a disturbance of normal functioning” ( http://www.thefreedictionary.com/disorder ).