- The Guardian, Saturday 19 August 2006
Deconstructing the evidence-based discourse in health sciences: truth, power and fascism. Even from looking at the title, you just know this academic paper from the September edition of the International Journal of Evidence-based Healthcare is going to be an absolute corker. And it uses the word "fascist" (or elaborate derivatives) 28 times in six pages, which even Rik Mayall in The Young Ones might have described as "overdoing it".
Now obviously postmodernist intellectuals are about 1,000 times more intelligent than me, because I only know about science and computers, but I found this paper so confusing I thought it might be a spoof. After all, who could forget the Sokal hoax, where a professor of physics at NYU submitted Transgressing the boundaries: towards a transformative hermeneutics of quantum gravity, a deliberately meaningless joke article purporting to undermine his own discipline, to Social Text, a leading journal in the field, and saw it published, to universal delight?
But this is very real, very turgid, spectacularly offensive, and completely misunderstands its target. Here's what they put in the "objectives" section of their abstract: "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." Let me put my fascist cards on the table and point out that these are not "objectives". In case you haven't heard of the continental philosopher Felix Guattari, here is a quick quote from his other work: "We can clearly see that there is no bi-univocal correspondence between linear signifying links or archi-writing, depending on the author, and this multi-referential, multi-dimensional machinic catalysis."
Such characters are being recruited to attack evidence-based medicine, and the argument of this paper seems to be: evidence-based medicine rejects anything that isn't a randomised control trial (which is untrue); the Cochrane Library is the chief architect of this project; and this constitutes fascism.
Firstly, they are simply wrong about the Cochrane Library (which simply produces good reviews of published literature): it does not only use trial data. But there is a more important general issue here. Evidence-based medicine is widely perceived as being soulless, and algorithmic: the last thing we'd want from doctors. But this is a foolish misunderstanding. EBM is about using quantitative information, in concert with all other forms of knowledge, sensibly, in a clinical context. It does not denigrate other forms of knowledge.
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?