My complaints about that post-modernist screed against evidence-based medicine have elicited some responses.
First up is a Calvinist post-modernist who defends the work by mischaracterizing the criticisms of various bloggers, including me, as:
“Chuckle, chuckle… stupid postmodernists… Sokal… grain of truth surrounded by words I don’t understand… chuckle, chuckle… ridiculous… stupid postmodernists… QED.”
Umm, no. I don’t see that in any of the posts about it. In my own, I said that the accusations of fascism were over the top, that I had read it and found it full of jargon (that does not mean I didn’t understand it), and my primary complaint was that despite making a plea for alternative ways of understanding medicine than evidence-based models, the paper did not propose any positive arguments for any specific alternative. It’s intellectually empty.
Just like our po-mo Calvinist’s complaints. He’s a creationist, so I guess it’s just an ingrained reflex to immediately raise a straw man and start flailing at it.
Much more satisfying, even if he does open the article by damning me (that’s so redundant, anyway), is Orac’s scourging. Call it the Passion of the Post-Modernist—watch that whip fly, see the gobbets of flesh splatter, observe the beads of oily sweat on Orac’s muscular arms as he wields the cat pitilessly. In other words, you might not want to look if you’re at all squeamish.
Alex Whiteside says
They’re not even particularly clever philosophers. Their entire argument is “evidence based medicine is dominant, and this is unfair”: it’s effectively a rant. There’s no attempt made to state their propositions (“Predictions can be made without prior knowledge of the behaviour of the system they aim to predict”? “Prior observations are invalid predictors of future behaviour of a system”?) or examine the possible implications thereof. Their refusal to accept an evidence-based form of reality is comes across as a selective form of pathological skepticism.
Consider that evidence-based medicine is just a synonym for reality-based medicine: as any good metaphysical subjectivist will tell you, reality is only “real” as the abstractions and information we can glean from our perceptions of it, which is the underlying principle of the scientific method.
This whole evidence-based knowledge is so passe. Faith-based and I-want-it-to-be-true-based knowledge is the wave of the future. In fact I can’t wait for faith to push aside evidence in the fields of civil, electrical, and mechanical engineering.
There is no reason that bridges, buildings, public water systems, public roads, circuit boards, panel boards, cars, planes, and cruise missles designed on faith can’t work just as well as ones based on so-called “evidence”. There isn’t one example ever of a faith-based design not working as well as an evidence based design to solve the same problem. But there are numerous instances of engineers making mistakes so evidence obviously has limits that faith does not.
Yup, no flaws or logical fallacies in my statements. None at all.
OH NOOO ! Run away in terror! Hide in underground bunkers and seal the doors, leave the cities and seek hide in the wildernes, or commit suicide if you can’t escape ! Anything is better than THAT ! Combination of calvinistic presuppositionalism with po-mo yelds the most terrifying weapon of mass debility ever invented ! All your thoughts become relativized within a couple of seconds after exposure, and you will become a cortically dead vegetable unable to decide anything, included whether to urinate or not, because thinking “my bladder is full/empty” would be a nanofascist oppressive truth-claim based on othewise baseless presuppositions….
My favourite take on PoMo/Deconstructivism was Chip Morningstar’s article, “How To Deconstruct Almost Anything“. A nice take on the whole movement.
Tony Jackson says
One final thought before I go and have a shower:
This crap from Holmes et al., was funded by the Social Sciences and Humanities Council of Canada. This was the funding body that turned down Brian Alters’ grant to study creationism on the grounds that Dr Alters didn’t provide “adequate justification for the assumption in the proposal that the theory of evolution, and not intelligent-design theory, was correct.”
Keith Douglas says
Tony Jackson: As a sometime researcher in the humanities in Canada, you’ve pointed out that I should be twice embarassed. I should look more into SSHRC’s review process. I wonder if they have “bullshit” screeners before actual peer-review …
TorbjÃ¶rn Larsson says
Our calvinist postmodernist creationist (hrrgh…, that was a mouthful) flails away and asking for summaries without noting that the threads already constitute a comprehensive critique, even before Orac went through with his analysis.
“Feyerabend didn’t have a lot of patience for experts who dismissed ideas they knew nothing about, without argument.”
“The arguments against astrology were so simplistic and wrong that they could often be used to argue against science itself. They showed a total lack of familiarity with even the basics of astrology (and that makes arguing against astrology very difficult indeed).”
Debunking junk science can be made directly and indirectly. With the later debunking it suffice looking at one of the basic ideas and its results. Indirectly debunking astrology is done in an armchair.
Even I can do that by noting the usual double whammy:
1) that there aren’t place for new fundamental interactions (due to compatibility with gravity and entropy observations) so assumed astrology causation has no mediator except gravitation which drowns in earth gravity and its local fluctuations.*
2) that signals are at fastest luminal but not instantaneous as astrology demands.
I guess I don’t have a lot of patience for Feyerabend.
*That should properly demand a rough calculation or possibly observations, but I feel lazy today. The armchair is so plushy…
Julie Stahlhut says
You can follow one of the links from the “Calvinist post-modernist” to a Peter Pitts editorial at roanoke.com. Interesting (and somewhat more reasonable) take on the whole thing there, but Pitts still badly conflates a few different ideas.
One underlying difficulty: Medical research is (as it should be) a hypothesis-driven endeavor that makes use of principles of experimental design and statistical analysis. Medical practice is, by its nature, somewhat anecdotal — a physician normally treats one patient at a time. If you show up in your physician’s office with, say, chronic pain due to a joint injury, your physician makes use of evidence-based medical research to prescribe the regiment of medication and physical therapy that’s been clinically shown to be most likely to help and least likely to have unpleasant side effects. But, if you’re the one patient in 1000 who gets a skin rash and a painful case of funny tummy from the medication, and you can’t make it to your physical therapy appointments beyour physician will have to exercise clinical judgment and try another medication. (One presumes that the second medication, of course, also has clinical evidence supporting its use, even if it’s not “the best” thing to try first.)
Pitts also writes that genomic technology has promise for optimizing treatment for each individual patient. Perhaps true (and maybe even affordable someday ), but there’s certainly nothing about genomics that challenges the idea of evidence. It simply allows us to account for variation on an individual basis rather than pooling it under some statistical measure of variance.
Whew! From the way you described the “Calvinist post-modernist”, I thought you were talking about that truly astounding douchebag, Robert O’Brian.
But when I clicked through and saw that it had been typed, rather than ham-fistedly sketched out in crayon, I knew we had been spared one of his know-nothing diatribes (or worse, one of his ridiculous “illustrations.”) Close shave, though.
Ken Camargo says
Again (as per the other thread), without even looking at whatever stupidity was posted at the place that PZ Meyers refers to, I’d like to caution against the use of that particular example to paint any philosophical (or sociological, or anthropological, and so on) enterprise that brings a critical look at how science is produced with such broad strokes. First, as someone else pointed out, there is a bewildering array of authors working in that area and with largely dissenting views; whereas there is admitedly a fair share of idiocy going on, there are others – like Thomas Kuhn, just to quote an example – that can’t be accused of not knowing their science. Second, using isolated examples as such to denigrate a whole field of study is tantamount to quote the infamous “Bell Curve” book to “prove” that all genetic research is racist.
Easy on the generalizations, folks.
I would like to add something to this, as I think I know a bit about how the word “evidence based medicine” can be bandied against a patient- by the type of people who wrote this article I am sure.
I have been dealing with an HMO like entity for a few years. ANYTHING that is new or different (except for Neurontin- go figure) has been met with resistance. Botox to manage pain- insufficient evidence, so see you- is one example. In discussions with these people about new ideas in the field of pain management, one is met with “But that is ONLY in rat studies”….. even if there is human studies available.
Now, on the other hand, the TENS machine, diaphragmatic breathing, laughter therapy, psych classes, relaxation, acupuncture, chiropracters, hydrotherpay, and that helmet thing that you use to control body functions are relied heavily upon.
The words “evidence based” are used as weapons against patients pursuing real medical breakthroughs. The “evidence” for their scam therapies is presented as gospel. If you are clueless, or in so much pain that you are willing to try ANYTHING and do not have the mental faculties to research or argue with your bevy of “experts” , then you are essentially hooped. (Unless you have a busy little “b” of a wife who freaks out when the resident psychologist pronounces as fact that one can heal CANCER AND WARTS with their mind. )
If you dig and see what the success rate of their program is, you see that the research is flawed. It is really badly flawed. The claim an 80 percent success rate- but the only thing is out of a few hundred clients, only a handful have responded to their follow up. Their success rate is then based on the few who responded to their inquiries. But- you do not know this unless you dig up the report online. A regular person would think from their first paragraph that 80 percent of 300 odd people were functional after completing their regimen. ( and even with my ridiculously poor statistics skills, I was able to figure it out after reading the article…)
You look up their claim that relaxation is good for back pain. Unfortunately, the exclusions to the study include people who have an actual diagnosis and pathology. So their study is only related to those with NON SPECIFIC back pain. Hmm….. but the people in their program have specific diagnoses, and failed surgeries, etc….
Yeah—- so evidence based is not REALLY evidence based- like prayer study people they pick and choose what to broadcast, and hope to hell that no-one ever actually looks up the stuff for real.
And that is why I am glad that PZ brought this to my attention. Because it just reinforces that there are agendas everywhere, and even if science can be manipulated by ideologies, at least later on there is a way of proving or disproving the truth of the claims made . With this other “thing” there is the nebulous lies and hopes and faiths and all that jazz that just are wrong on so many levels.
That said- when I look at the word Neurontin, I am wondering how so many docs and all got so into a drug that really is not all it was cracked up to be. Do physicians and insurers have poor research and statistic skills? How do these medical fiascos happen?? What is the culpability of medical journals for publishing stuff that is biased in favour of certain drugs because their author is bought and paid for by the drug companies? Do regular people like me finally get tired of all the bs and stop believing in the “truthiness” that is offered by these companies? Do we become cynical about all things scientific if we see how numbers can be made to say different things if a company holds back key pieces of information?
Who to trust and who to turn to?