Respectful Insolence

ResearchBlogging.orgI hate postmodernism.

Well, not exactly postmodernism per se, but I hate it when pseudoscientists and purveyors of dubious “alternative” medicine treatments invoke bizarre postmodernist-sounding arguments to attack science or, in the case of medicine, science- and evidence-based medicine. Usually these attacks involve a claim that science is nothing more than one other “narrative” among many others, a “narrative” that isn’t necessarily any more valid than any other. Even worse, these sorts of arguments often claim that science (or, in this case, evidence-based medicine) is nothing more than a sort of hegemony of the power structure being imposed upon the very definition of “data” or “reality,” the implication that it’s us white males whose hegemony rules (and, presumably, must be resisted) doing the imposing, as if there are no inherent characteristics in science that make it a more valid means of assessing reality as it exists than, for example, personal anecdote and “experience.”

A couple of years ago, I came across the epitome of silly postmodernist rants (a.k.a. “PoMo”) that, possibly until now, has exceeded anything I had ever seen applied to medicine before. Basically, it was an all-out assault on the paradigm known as evidence-based medicine (EBM), a paradigm that ranks types of evidence by their rigor, ranking as the highest form of evidence the well-designed, randomized, double-blinded clinical trial. In this all-out assault, the authors of the article in essence played the argumentum ad Nazium gambit and labeled EBM “microfascism” in a hilariously over-the-top screed entitled Deconstructing the evidence-based discourse in health sciences: Truth, power, and fascism. Later that year, after a barrage of withering criticism, the authors of the study, David Holmes, Stuart J. Murray, Amélie Perron, and Geneviève Rail launched an even more hiliarious response. I strongly encourage you to take a trip back to two years ago and read about it before proceeding. Why?

Because three of the original Four Horsemen of the PoMo-calypse ride once again, spreading verbiage, confusion, and, above all, headaches to anyone who tries to penetrate the denseness of their blather, and they’re even more unhappy than ever about EBM. One of the bloggers at Holford Watch let me know about it, and I’m not sure if I should thank him or or curse him for it. We’ll see. In the meantime, the abstract alone is some of the most concentrated PoMo gibberish I’ve ever seen:

Drawing on the philosophy of Michel Foucault and Gilles Deleuze, this paper interrogates the constitution of ‘evidence’ that defines the evidence-based movement in the health sciences. What are the current social and political conditions under which scientific knowledge appears to be ‘true’? Foucault describes these conditions as state ‘science’, a regime that privileges economic modes of governance and efficiency. Today, the Cochrane taxonomy and research database is increasingly endorsed by government and public health policy makers. Although this ‘evidence-based’ paradigm ostensibly promotes the noble ideal of ‘true knowledge’ free from political bias, in reality, this apparent neutrality is dangerous because it masks the methods by which power silently operates to inscribe rigid norms and to ensure political dominance. Through the practice of critique, this paper begins to expose and to politicise the workings of this power, ultimately suggesting that scholars are in a privileged position to oppose such regimes and foremost have the duty to politicise what hides behind the distortion and misrepresentation of ‘evidence’.

Wow. Just wow. This is almost as good (bad) as whole “microfascism” rant. Basically, it’s the same tired old refrain that science is nothing more than the existing power structure exerting its will to enforce “conformity.” Because the article is not available to a lot of my readers, I feel obligated to quote fairly liberally from it to give you a flavor of just how ridiculous it is. The authors’ intent is made plain right from the first sentence:

What constitutes ‘evidence’ in the health sciences? Without too much hesitation, we might say that scientific evidence is worthwhile if it can be repeated, independently verified and measured according to standards upon which we can all agree. We might call this the ‘common sense’ view and commonsensically believe that these conditions hold as true not just in the sciences but also in our daily dealings in the world. We might even say that nothing could be more straightforward, that evidence in this context is obvious or ‘self-evident’ and that in the end, ‘seeing is believing’. In this paper, we suggest that this cheerful proverb stands as a kind of emblem for the dangerously naïve commonsense view on truth that has spread throughout our culture. We argue that this view betrays an almost unshakeable faith in the human capacity for unbiased or objective observation and analysis. Ultimately, this means that science becomes supplanted by ideology, and scientific inquiry becomes a ‘methodological fundamentalism’ (House, 2006).

Yes, it’s the old “fundamentalism” charge leveled against those of us who actually think that scientific rigor is important in determining what treatments work and what treatments do not. It’s the same charge routinely leveled against evolutionary biologists by creationists, be they “intelligent design” creationists or the old hard core young Earth creationists. It’s the same charge leveled by pseudoscientists of all stripes against scientists who correctly tell them they are pseudoscientists: That scientists are rigid, unable to think “outside the box,” to them, as I mentioned before, science is nothing more than a Tool of the Man to enforce cultural hegemony and, more importantly, to keep the Brave Mavericks down. In fact, the entire premise of this article is based on a huge straw man, as is shown here:

This paper discusses the constitution and status of ‘evidence’ in light of the almost evangelical rise of evidence-based health sciences (EBHS), including nursing. One salient example is the Cochrane Library, which provides EBHS acolytes with a database of ‘systematic reviews’ that has been faithfully constructed according to the evidencebased movement (EBM) directives. Thus, within the Cochrane Library’s hierarchy of allowable ‘evidence’, the randomised controlled trial (RCT) is taken as the ‘gold standard’, and proponents will scoff at any criticism because the RCT can be repeated, independently verified and measured according to standards upon which we can all (presumably) agree. It is not rocket science, or so they will say. But here with the seemingly innocent exaltation of the RCT, we find an explicitly hierarchical ranking that denigrates the evidentiary value of clinical experience; and similarly, qualitative research based, among other things, on participants’ narratives is ‘systematically’ ranked lower in value as ‘evidence.’

Thus, the most faithful proponents of EBHS must adopt a position in which “seeing is believing”–where evidence is presumed to be visual, immediate and incontestable. It is as if the evidence itself spoke the truth, and EBHS finally realised the dream of a pure science, a science free from the inherent messiness of human language, of human interpretation, of human values or, indeed, of anything recognisably human because the body that EBHS treats is the ‘average body’ generated by the RCT, without any experimental body. Nevertheless, within the culture of the health sciences, EBHS now circulates as a kind of fundamental truth, and it can do so because EBHS has come to control the terms by which evidence appears. The EBM constitutes a vast matrix of influence from funding bodies and academic institutions to nursing best-practice guidelines (BPGs) and multiple-related postulates that inform day-to-day heath care practices. In other words, for EBHS, ‘seeing is believing’ because EBHS carefully limits what can be seen in the first place. EBHS limits not only what can appear within our visual field but also how it will appear and how that evidence will be framed. EBHS appeals to a culture that is taught to embrace simple directives and to be suspicious of intellectual critique.

A more massive strawman it is hard to imagine. Nowhere does it say in EBM that evidence must be “visual, immediate, and incontestable.” What a load of rubbish! If evidence were that obvious, then EBM wouldn’t even be necessary. Certainly that tool of EBM, the meta-analysis, would not be necessary because the very reason to perform a meta-analysis is to try to develop a consensus when there are multiple trials that do not all agree. In fact, EBM can be viewed as a means of trying to make sense of clinical data supporting various treatments, even when the data are not clear or are conflicting. “Seeing is believing?” Ha! If only EBM were that easy! Actually, if EBM were that easy, anyone could do it.

Murray et al then go on to claim that “seeing is not always believing,” taking arguments about the social sciences and invoking, of all things, the Rodney King trial and the videotape evidence used, concluding:

Our point in referring to what many saw as a manifest injustice is to call attention to our ways of seeing and the often hidden politics of the evidence to hand. In the King case, many of us would draw a very different conclusion from the visual ‘evidence’, even though it is exactly the same piece of evidence: it can be repeatedly screened, its accuracy can be independently verified and it can be measured according to standards upon which we can all (presumably) agree. Although the evidence seems to present a truth that is pure and simple, as Oscar Wilde once quipped, the truth is rarely pure and never simple. The evidence cannot simply speak for itself because the meaning of that evidence is of another order altogether. Thus, we must worry about the ways in which evidence is manipulated and contextualised under the aegis of efficiency, in the name of political expediency or in the name of scientific progress, and sometimes all three at once, as in the famous case of the Tuskegee Syphilis Study, to offer one tragic example.

Got it? Because a jury interpreted a videotape in a way that didn’t make sense to most people, that means that EBM is wrong, a false, politicized concept! Truly, you can’t make stuff like this up. At least, no one with a scientific outlook can, except perhaps as parody. Never mind that the jury of the Rodney King trial were not scientists, and it wasn’t the scientific method being applied. Indeed, one reason the scientific method exists is to serve as a check against the very sort of problems in human perception that allow verdicts like that of the Rodney King trial to occur. In fact, I’m surprised they didn’t bring up the O. J. Simpson verdict as well. And, of course, EBM is just like the Tuskegee Syphilis Study, if you’re to believe these twits. Never mind that in addition to being incredibly unethical the Tuskegee Syphilis Study was actually pretty dubious science given that much was already known about the progress of untreated syphilis.

The most hilarious part of this whole article is its defense of Holmes’ previous “microfascism” nonsense. But first, he more or less lays out that his purpose is to politicize EBM:

Our critical perspective develops some of the five shortcomings of the EBM succinctly described by Cohen, et al. (2004), namely, that EBHS [1] relies too heavily on empiricism, [2] relies on too narrow a definition of evidence, [3] ironically, lacks any evidence of its own efficacy, [4] is of limited use for individual patients and [5] threatens the autonomy of the clinician or patient relationship. In addition, however, our work has attempted to politicise the ways of seeing that have become common in the health sciences as a result of the EBM agenda (Holmes, et al., 2008; Holmes, et al., 2006a, Holmes, et al., 2006b; Murray, et al., 2007). In other words, we have sought to examine, to bring to light, the unexamined postulates that underwrite the EBM. From this critical perspective regarding what is now the dominant episteme, we claimed that the EBM was politically dangerous (Holmes, et al., 2006a). Relying on the French philosophers Deleuze and Guattari (1987), we argued polemically that the EBM is akin to a totalitarian political structure and, consequently, that its way-of-seeing is informed by a politically dangerous ideology. In a nutshell, we noted that the EBM wholeheartedly adopts corporate models of efficiency and accountability, right down to a corporate lexicon; EBM relies reductively on quantitative evidence in which RCTs are fetishised; EBM denigrates other forms of knowledge, including clinician experience and patient testimony; finally, EBM evacuates the social and ethical responsibilities that ought to distinguish health care professions, such as nursing.

Of course, what really bugs the authors about EBM is that it values least the type of evidence that they value the most: personal experience, in other words, the kind of “evidence” that supporters of “alternative” medicine value more than anything else. That, and the fact that they don’t like being constrained by EBM, “best practice” guidelines, or anything else. I’ve discussed why the description of EBM above is a load of steaming, stinking, fetid dingos’ kidneys before; so I won’t repeat myself. Suffice it to say that EBM explicitly integrates clinician experience into its guidelines. But the penultimate “triumph” of this article is this:

Unsurprisingly, then, proponents of the EBM have shot back at us, from blogs to journal articles, accusing us of relying on jargon-filled postmodern theories that stand in the way of the EBM’s number one priority, to ‘better man’s lot’, as one commentator put it (Jefferson, 2006, p.393). Indeed, we are charged with a kind of recklessness, a blind and wanton vendetta against the EBM practitioners at the expense of patient health and well-being. At first blush, this is a clever rhetorical strategy. We ivory-tower ‘theorists’ are easily pitted against the ‘practitioners’ when the practitioners are celebrated as nobly serving humanity down in the trenches; thus, according to such a binary logic, we are demonised as theoreticians who ignorantly obstruct those pious practitioners who only want to do their job! Despite EBM’s evangelical rhetoric of salvation, this unrepentant moralising soon betrays its superficiality. In response, we have argued (Murray, et al., 2007) that theory is a kind of practice and that our critical intervention demands of practitioners a certain intellectual integrity and honesty. In fact, this is what should count as ‘good science’ and ‘persuasive evidence’, quite distinct from the ‘state science’ (Foucault, 1997, p.37) that the EBM has become. We demand that they think not only about the means by which better outcomes (an EBM mandate) are justified but also about the wider social and political effects of these means and ends together.

Poor babies. Write nonsense, and of course you can expect some harsh criticism. They also misrepresent the criticisms. In fact, the criticisms were not that Holmes et al were somehow standing in the way of bettering man’s lot through EBM. It was that they were misrepresenting what EBM was, misrepresenting what science was, and, worst of all, representing science and EBM as a form of fascism. If any response was “superficial,” it was theirs. It also reveals that what is most important to the postmodernist is not science but the social and political effects of science. As hilarious as the above jargon is, it pales in comparison to this pièce de résistance:

There is no such thing as a ‘statistically average patient’, and the vast majority of patients cannot accurately be described as white, male, Western or heterosexual, which are increasingly troubled identity categories. Thus, we suggested that ways-of-seeing were epistemic, that is, largely a product of shifting social and historical values. As evidence, we cited the historical pathologisation of homosexuality along with the hysterisation of the female body, both of which are now widely recognised as bad medicine, but designated as Truth in previous years. One way to combat such methodological fundamentalism is what we might call methodological pluralism, where a plurality of discourses and knowledge is encouraged. In this way, we hope to resist the Orwellian ‘Newspeak’ that reigns in the health sciences–buzzwords like ‘best-practice champions’, ‘gold standard’ and ‘spotlight organisations’, which work to ensure a highly normative, uniform and rigidly circumscribed way of seeing, speaking and thinking.

In short, we must find ways to combat the procrustean policies that have hijacked many modes of scientific inquiry and have led instead to a tangled web of ideological apparatuses, including Big Pharma; innumerable government lobbies; professional healthcare associations, such as the Registered Nurses’ Association of Ontario (Canada) and its compulsive endorsement of ‘best-practice guidelines’; academia and its research sponsors; the convergence of research and business with multiple stakeholders, both public and private; paradigms rewarding the bioentrepreneurship of biotech companies; service industries from the human genome sciences to multinational agribusiness complexes; corporate models from the ground up, including accountability practices and the obsession with quantification; the legal-juridical complex; and the insurance industry (Murray, et al., 2007). This list is by no means exhaustive, but it indicates that the challenges are legion. Nothing less than a multitude of micro-resistances is called for in each of these domains. In the face of a strategic fundamentalism that closes off debate, we must be mindful to resist in such a way that we open up critical debate and question those mechanisms that work to seduce us into complacency. In short, the health care sciences ought to work to foster an ethic of patient care that resists technocracy, that is, an ethic that will be respectful of and responsible for patient diversity for the good life (Murray, 2007).

I’m particularly amused by their use of the word “procrustean.” It’s a word I had never heard of before, and, as anyone who reads this blog knows, I have a pretty darned good vocabulary. So I looked it up. The derivation of the word is from Procrustes, a mythical Greek giant who stretched or shortened captives to make them fit his beds, and it’s defined as “producing or designed to produce strict conformity by ruthless or arbitrary means.” In other words, to this PoMo crew EBM, like all good “microfascism” requires absolute “conformity” and enforces it by ruthless means. This is such utter nonsense on so many levels that it’s as breathtaking in its hyperbole as the original “microfascism” article while at the same time being yawn-inducing in its utter tedium. Yes, yes, we know. That nasty science and that nasty EBM construct restrict your freedom to consider any source of evidence you want, no matter how dubious. All this entire attack is is the “health freedom” movement dressed up in incomprehensible “diversity”-promoting PoMo jargon to an even more laughable extreme than their previous articles.

The Four Horsemen of the PoMo-calypse ride again, indeed–at least three of them anyway. Or maybe I should call them the Three Out of Four Horsemen of the Procrustean PoMo-calypse.

The passage cited above is also a typical example of how such people can take the germ of an idea that’s a valid criticism of randomized clinical trials and their importance in EBM made by even advocates of EBM (for example, that RCTs can at times be very difficult to apply to individual patients) and go straight off the deep end with it into a tangle of PoMo gibberish so dense that it defies understanding. I could discern the “science was wrong before” argument so beloved of cranks of all stripes, along with a lot of other logical fallacies. Once again, what matters more than anything else the the Horsemen is the political and social implications; the authors want science to serve their political agenda, not the other way around, because, to the Horsemen at least, EBM must obviously controlled by all the things the they hate, the insurance industry, “bioentrepreneurship” and big pharma, the veritable Roots of All Evil and Threats to Diversity. To achieve their aim of destroying EBM (with a minor concession that there would “still be a role” for RCTs, although the implication is that that role will be small), the whole argument boils down to a predictable appeal to other ways of knowing, in the form of advocating “resisting technocracy” and, above all else, promoting “diversity” (whatever that means).

Of course, to the PoMo quack, “diversity” means nothing more than the freedom to do whatever one wants or to believe whatever one wants, evidence be damned–because, as people like Murray et al tell us, “evidence” is hopelessly corrupted by the power structure, whatever that means. Science is therefore nothing more than another way of knowing, with no inherent superiority to other ways of knowing how nature works or what treatments work the best. Although the Horsemen don’t come out and say it, the implication of their argument is that if a quack believes that liver flukes cause cancer and that zapping the flukes with a cheap electrical device will cure all cancer, who is science or that nasty EBM to say that that’s not true? In any case, two years later, I still stand in awe of the amount of sheer B.S. concentrated into such a brief little paper.

It’s like a black hole of PoMo stupid.

REFERENCE:

S. J Murray, D. Holmes, G. Rail (2008). On the constitution and status of ‘evidence’ in the health sciences Journal of Research in Nursing, 13 (4), 272-280 DOI: 10.1177/1744987108093529

Comments

  1. #1 gimpy
    September 10, 2008

    Do you ever feel really stupid when you try and read guff like this?
    I certainly do. I just can’t follow it. I get confused by the needlessly long words. Since the authors brought up ‘Orwellian Newspeak’ I highly recommend that everybody read this brilliant essay by the man himself ‘Politics and the English Language’. Its conclusions are relevant to anybody who has ever laid ink to paper or fingertip to keyboard.

    (i) Never use a metaphor, simile, or other figure of speech which you are used to seeing in print.

    (ii) Never us a long word where a short one will do.

    (iii) If it is possible to cut a word out, always cut it out.

    (iv) Never use the passive where you can use the active.

    (v) Never use a foreign phrase, a scientific word, or a jargon word if you can think of an everyday English equivalent.

    (vi) Break any of these rules sooner than say anything outright barbarous.

  2. #2 Kathleen Seidel
    September 10, 2008

    This’ll turn your awe to laughter: The Postmodernism Generator.

  3. #3 Calli Arcale
    September 10, 2008

    I like that, gimpy. Thank you for sharing that link! #3 puts me in mind of something Antoine de St-Exupery said. He was an aerospace engineer, a pilot, and a writer.

    “A designer knows he has achieved perfection not when there is nothing left to add, but when there is nothing left to take away.”

    In engineering, this speaks to the KISS principle (Keep It Simple, Stupid), and cautions against the temptation to add unnecessary features. In writing, it is perhaps even more important, because anything in your text which is not absolutely important will run the risk of boring the audience or, worse, confusing them. Anton Chekhov also reinforced this principle in what came to be known as Chekhov’s Gun: do not include an item in your story unless you are going to use it at some point. I think a lot of today’s television and film writers would do well to learn this lesson.

  4. #4 Sharpie
    September 10, 2008

    Such PoMo obfuscation reminds me of Lintilla in the Hitchhiker’s Guide to the Galaxy. In order to deal with the problem of 500 billion (and counting) Lintilla clones, lawyers “argue about what murder actually was, including trying to redefine it, repronounce it, and respell it in the hope that no-one would notice.”

  5. #5 bcpmoon
    September 10, 2008

    Well, if there is micro-fascism, you need “micro-resistances”.
    The french aren´t really that short…

    Ohm sweet Ohm…

  6. #6 Ruth
    September 10, 2008

    EMB tells me jumping out of windows from tall buildings is unhealthy, but the PoMo authors are welcome to challenge this narrative.

  7. #7 bcpmoon
    September 10, 2008

    Ruth,
    be careful! The trials were inconclusive…
    see http://www.bmj.com/cgi/content/full/327/7429/1459

    Just to prove that science is more fun…

  8. #8 SC
    September 10, 2008

    Relying on the French philosophers Deleuze and Guattari (1987)

    That tells you everything you need to know.

    I’ll have to come back and read the earlier paper later (checking in from my office for the first time; everything looks so different!). People like this make me furious. Their nonsense makes it that much harder for scholars in the social sciences (studies) and history who have something meaningful to say about science to be listened to. And they should read Foucault again – they’re misunderstanding and misrepresenting his arguments, in Power/Knowledge and elsewhere. Idiots.

    [Dude - You'd never heard of a Procrustean bed before? OK, I'd never heard "armamentarium" or "three yards and a cloud of dust" before your recent post, but still...:)]

  9. #9 D. C. Sessions
    September 10, 2008

    It was much easier for me to read by substituting “engineering” for “health care” and applying a (remarkably few) related changes. Aside: they’re so busy with philosophy and politics that you could just about substitute anything without much changing the overall effect.

    Anyway, the results were absolutely hilarious.

    Maybe I should have a look at what would happen substituting “farming” next.

  10. #10 Ahistoricality
    September 10, 2008

    Echoing SC, above, what makes this even more tragic, is that it’s bad postmodernism. Postmodernism is not relativism, nor is it anarchism, nor is it conspiracy-mongering, though those are the blind alleys into which shockingly many postmodernists steer, eventually.

    The reason they’re publishing this in a Nursing journal? They couldn’t get at actual theory journal to take them seriously.

  11. #11 jayh
    September 10, 2008

    I am reminded of George Orwell’s maxim: ‘Some ideas are so stupid that only intellectuals can believe them.’

    There are a number of entertaining Pomo generators on the net, like this one:

    http://www.elsewhere.org/pomo/
    (each reload produces a new essay)

    They also have a teenage poetry generator

  12. #12 Interrobang
    September 10, 2008

    I was going to say about the same thing as Ahistoricality; it’s bad postmodernism, and it does, in fact, rest on a straw-construction (that is that evidence = “seeing is believing” et cetera). I actually have an advanced degree in an English-related discipline, so I actually found that pretty easy to follow, inasmuch as it goes anywhere. I’m inclined to agree with the centrality of narrative to the human experience; if we didn’t do narrative, we wouldn’t be able to understand things like time or cause and effect (you might as well try to remove metaphor from language as narrative), and I’m inclined to agree that science does, in fact, have a whole bunch of operative narratives, but big deal, so does everything else.

    What we were always taught in grad school was that postmodernism, like most of the other analytical isms (like Marxism, economic neoliberalism, feminism [in the analytical sense], deconstructionism) were just a set of analytical tools that you kept around and pulled out as required to attack any particular problem. Since problems in the arts and/or social sciences rarely have hard-and-fast answers, if you ran the same analysis using three or four of these different frameworks, whatever stayed basically unshifted (despite shifting your frame of reference) was likely to be about as close to objective truth as you’re going to get. Of course, that approach works better with some problems than others.

    The danger is turning one of your tools into your entire worldview. Then you get into that old problem that when all you have is a postmodernist hammer, everything looks like a narratively-constructed hermeneutical nail.

  13. #13 David C. Brayton
    September 10, 2008

    While I’ve heard of post-modernism before I read this, I was left agape at the sheer lunacy of their screed. PoMo is nothing but a bunch of gibberish. Wow. Just wow.

  14. #14 jayh
    September 10, 2008

    They start with a partial truth, and expand it beyond all sense.

    There is, of course, some politicizing of science, what gets funded (notice how little research into the possible medical applications of cannibis) and what doesn’t but this is to some degree inevitable and eventually self correcting. Even as it is, the scientific method is a good way to eliminated the ineffective.

  15. #15 Rogue Epidemiologist
    September 10, 2008

    Hmm … I know grad students who sound like that. It’s the stuff undergraduate seminars are made of! I only sound like that when I’m feeling acutely drunk and satirical. It’s too easy to gloss over the stupid with big words.

  16. #16 PrimroseRoad
    September 10, 2008

    These types of misunderstandings of postmodernism are terrifying sometimes. Deleuze and Foucault weren’t against evidence, just the idea that Enlightenment represented a version of humanism in which only certain priviliged humans could “shed light on” what had been previously in the dark. Both would have likely been bitterly opposed to New Age woo. I am sure that the papers you’ve described above (and the way that they’re used as “evidence” for pseudoscience-based health scams) make many of those who work with postmodernist theory sad in the same way that The Secret makes those who work with quantum physics sad …

  17. #17 HealthEd
    September 10, 2008

    This really takes me back, to undergrad English lit and Modern Culture and Media courses. Reminds me why I decided to abandon the academy after graduation!

    Ahistoricality and Interrobang have it right. Postmodernism can be a useful way of looking at very subjective topics, but “whether or not this antibiotic will cure this infection” isn’t one of them.

    That’s one of my major beefs with a lot of POMO stuff — a veritable sea of 10-dollar words with usually very little substance swimming within. A lot of it is big talk solely for the purpose of running verbal circles around the reader/listener and therefore seeming smarter. (Derrida, I’m looking at you)

    I took a semester of lit theory (had to) and it was exactly what the title in the course catalog said — 4 months of pure theory, not applied to any works of literature. Now, take a novel and show me how Lacan, Foucault, Barth, etc. would approach it, and I’ll learn something. Force me to read them without any context and I lose all sense of meaning.

    Orac, did the authors of this paper cite even one tiny shred of an example of how other approaches can be just as helpful as, or superior to, EBM? If they didn’t, they really misserved their readers. And confused the hell out of a bunch of nurses (if not boring them to tears).

  18. #18 HealthEd
    September 10, 2008

    This really takes me back, to undergrad English lit and Modern Culture and Media courses. Reminds me why I decided to abandon the academy after graduation!

    Ahistoricality and Interrobang have it right. Postmodernism can be a useful way of looking at very subjective topics, but “whether or not this antibiotic will cure this infection” isn’t one of them.

    That’s one of my major beefs with a lot of POMO stuff — a veritable sea of 10-dollar words with usually very little substance swimming within. Much of it is big talk solely for the purpose of running verbal circles around the reader/listener and therefore seeming smarter. (Derrida, I’m looking at you)

    I took a semester of lit theory (had to) and it was exactly what the title in the course catalog said — 4 months of pure theory, not applied to any works of literature. Now, take a novel and show me how Lacan, Foucault, Barth, etc. would approach it, and I’ll learn something. Force me to read them without any context and I lose all sense of meaning and start pondering whether suicide can be a blessing.

    Orac, did the authors of this paper cite even one tiny shred of an example of how other approaches can be just as helpful as, or superior to, EBM? If they didn’t, they really misserved their readers. And confused the hell out of a bunch of nurses (if not boring them to tears).

  19. #19 D. C. Sessions
    September 10, 2008

    A lot of it is big talk solely for the purpose of running verbal circles around the reader/listener and therefore seeming smarter.

    I’ve had exactly one person try that on me, and after a thoughtful pause asked him to take it out of the grand generalities he was using and apply it to a concrete example. I suggested that he apply a postmodernist analysis to the question of whether or not holes exist, in the context of semiconductors.

    Never had a problem since.

  20. #20 Phoenix Woman
    September 10, 2008

    I was going to chime in on how these doofs weren’t even getting post-modernism right, but a bunch of people have already done that. :-)

    Sounds like they’re pulling The Von Dãniken Ploy: Throw around Big Words in an authoritative manner and hope no one who actually knows the topic pipes up.

    The way it works is thus: Carl Sagan described in one of his books (Dragons of Eden, I think) how he knew that EVD was absolutely full of shit when it came to his astronomy (not to mention his physics), but the descriptions of ancient Fertile Crescent culture and of archaeology in general sounded legit to him. Then he ran into an archaeologist who told him that he’d thought the exact opposite: He knew that EVD’s archaeological spoutings were bullshit, but by golly the astronomy sounded compelling.

  21. #21 HealthEd
    September 10, 2008

    Oops! sorry for the double post — my computer got hung up there.

    Funny example, D.C.!

  22. #22 Phoenix Woman
    September 10, 2008

    If M. Foucault were still with us, he’d tell these clowns to Foucault and die. (Sorry, couldn’t resist.)

  23. #23 I am so wise
    September 10, 2008

    Idiots who use pomo inappropriately are doing a real disservice to us all. Some of the best historians have been written by postmodernists or using postmodernist insights.

  24. #24 Harriet Hall
    September 10, 2008

    gimpy said,

    “Do you ever feel really stupid when you try and read guff like this? I certainly do. I just can’t follow it. I get confused by the needlessly long words.”

    It’s not the long words, gimpy, it’s the confused thinking. I know what procrustean and all those other words mean, but the text doesn’t make sense to me either. When a text makes you feel really stupid, it’s probably not your fault; it’s more likely the fault of the authors and the fact that they are not thinking clearly.

  25. #25 SC
    September 10, 2008

    Echoing SC, above, what makes this even more tragic, is that it’s bad postmodernism. Postmodernism is not relativism, nor is it anarchism, nor is it conspiracy-mongering, though those are the blind alleys into which shockingly many postmodernists steer, eventually.

    *clears throat* Well, you’re not echoing me if you’re including anarchism in that list. Anarchists have been among the most astute analysts of politics and science around. Peter Kropotkin was a great scientist, science writer/popularizer, and scholar of the relationship between science and society. C. Wright Mills, probably the best sociologist of the 20th century: anarchist. Chomsky: anarchist. Anarchism is no blind alley.

    There are hints that this and associated traditions are being revived. Here, perhaps :):

    http://scienceblogs.com/authority/2008/09/community_organizing_and_the_s.php

    (Since I’m the only one to leave a comment so far, I thought I’d spread the word. I’m in no way implying that the blogger in question is an anarchist…Which I don’t consider an insult anyway, being one myself.)

  26. #26 guthrie
    September 10, 2008

    C Wright Mills was an anarchist? That’ll explain it then. I’ve been reading bits of “The power elite” and wondering why his analysis makes more sense than anything else you see in main stream journalism etc.

  27. #27 vlad
    September 10, 2008

    “postmodernist analysis to the question of whether or not holes exist, in the context of semiconductors” Oh that’s easy. Electrons do not exist as they are only observable directly through an electron microscope (quantum coral(sp)), since quantum coral experiment was only possible through the application of technology which limits ones ability to different ways of knowing. The holes can not exist as there is no such things as electrons to be absent in their way of knowing. It could just as easily the Chi that is transferred through the either of existence by the manufacturing, design of the component or during the board layout process. Thus the component works on the intent of the designer and has nothing to do with holes.

    Sorry had been doing worst case tolerance analysis all day and have developed a personal distaste for as specific semiconductor component. This is of course absolute crap but if you de-frame all knowledge anything unfortunately becomes possible, usually stupid at the same time.

  28. #28 bug_girl
    September 10, 2008

    how weird is it that we both used “armamentarium” on the same day, but in different contexts?

    As soon as I saw the quote marks around “truth” I knew what kind of drivel they were spouting.
    Sigh.

  29. #29 D. C. Sessions
    September 10, 2008

    SC:

    I don’t think that anyone was arguing that POMO is incompatible with anarchism, only that the “pomo is not anarchism” — an identity being denied. Perhaps one might even be so bold as to propose that pomo does not even necessarily imply anarchism, but either way your list of anarchist postmodernists does not contradict the stated thesis.

    Then again that’s some very, very hoary premodern rhetorical analysis. Perhaps I spend too much time with discrete mathematics and am trapped in its strictures.

  30. #30 Zeno
    September 10, 2008

    How did they manage to write all that without running out of quotation marks? Surely the world’s supply was severely depleted by their promiscuous use of same.

  31. #31 SC
    September 10, 2008

    C Wright Mills was an anarchist? That’ll explain it then. I’ve been reading bits of “The power elite” and wondering why his analysis makes more sense than anything else you see in main stream journalism etc.

    Even better: a goddamned anarchist. From his letter to Harvey and Bette Swados, November 3, 1956:

    When I get back I’m going to write a solid, tight little critique of ‘Marxism today’ – about 80 pages. You see, I’ve set my stuff always against various forms of liberalism because those are dominant. But it could just as well – in fact easier for me – be set against Marxism. What these jokers – all of them – don’t realize is that way down deep and systematically I’m a goddamned anarchist. I’m really quite serious and over the next few years I’m going to work out the position in a positive and clear-cut way.

    - C. Wright Mills: Letters and Autobiographical Writings, 2000, UC Press, pp. 217-8 (very good by the way – edited by his daughters, who are both in publishing, I believe)

    I don’t think that anyone was arguing that POMO is incompatible with anarchism, only that the “pomo is not anarchism” — an identity being denied. Perhaps one might even be so bold as to propose that pomo does not even necessarily imply anarchism, but either way your list of anarchist postmodernists does not contradict the stated thesis.

    I think you’re misunderstanding me. Of course, I have no problem with the statement that pomo isn’t anarchism and doesn’t imply anarchism. I consider this obvious. The identity was being denied in that comment in defense of pomo; I deny it in defense of anarchism. But my point wasn’t really about the relationship between pomo and anarchism at all, and none of the anarchists I named were/are postmodernists (that would have been quite difficult for Kropotkin :)). I was countering specifically the suggestion that anarchism is some kind of dead end in terms of sociopolitical analysis (and specifically that of science).

  32. #32 SC
    September 10, 2008

    Oh – I meant to add:…But I can see how that comment might have been ambiguous. My apologies.

  33. #33 SC
    September 10, 2008

    Then again that’s some very, very hoary premodern rhetorical analysis. Perhaps I spend too much time with discrete mathematics and am trapped in its strictures.

    Kropotkin and Mills are two of the clearest, most logical writers I’ve read. I consider them models to emulate, and highly recommend their work.

  34. #34 Harry Eagar
    September 10, 2008

    This paper calls for R.A.N.G. analysis.

    Random Abstract Noun Generator. You run a paper — say, Holmes et al. — through the R.A.N.G., switching abstract nouns around unsystematically. The more switches you can make without changing the meaning, the higher the R.A.N.G. score.

  35. #35 NM
    September 10, 2008

    No such thing as an average patient?

    Isn’t life so much easier when you can express opinions on EBM and never have to look at actual data, understand statistics, or even talk to someone who is a patient?

  36. #36 IBY
    September 10, 2008

    That post modernist stuff was so stupid… How the heck do they make up stuff like this?!

  37. #37 kristina
    September 10, 2008

    Thinking beyond the PoMo blather (my graduate “training,” such as it isn’t, was in the Comp Lit Department at Yale, once the American home of deconstruction)—–there is something more insidious in all this theory and the 10$ words. The authority given to personal anecdote and experience and the David-vs-Goliath need to challenge the dominant narrative: There’s something in this of the script that anti-vaxers (Jenny & her band) steal a page from, knowingly or not. The post-modern impulse to undermine and rewrite the narratives indeed is having real-world results—a Pandora’s box worth, as it may turn out.

  38. #38 DLC
    September 10, 2008

    The Stupid of their blather burns brightly.
    I am reminded of the fellow who wrote an essay and got it published in a journal, only to later reveal that the essay was meaningless verbiage. At least that author had a point — that meaningless verbiage, if abstruse enough, could make it’s way past the editors. These people seem bent only on muddying the waters.

  39. #39 Azkyroth
    September 10, 2008

    Personally, I acknowledge two “ways of knowing”: the empirical (scientific) way, and the Biblical way. :P

  40. #40 Richard Eis
    September 11, 2008

    Yeah this isn’t new, i’ve seen this sort of thing before:

    “You didn’t let us play in your sandpit, so we think you’re game is for poo poo heads.”

    i think that’s a fair translation, n’est pas?

  41. #41 Christophe Thill
    September 11, 2008

    Note to the Horsemen… sorry, Horsepeople (no sexist language!):

    Don’t be an accomplice of microfascism. When you’re sick, reject all drugs elaborated through EBM procedures. If it leaves you with herbal tea, bloodletting, homeopathy and the doctrine of signatures, well so be it.

  42. #42 Orac
    September 11, 2008

    Well said. After all, claims that herbal tea, bloodletting, and homeopathy can cure, for instance, cancer must be just as valid a “narrative” as the scientific evidence showing the efficacy of surgery, chemotherapy, and radiation therapy can result in long-term survival, right? :-)

  43. #43 Christophe Thill
    September 11, 2008

    Also, how can you accuse scientists of being “naive”, when you yourself are so naive about science? Sorry, but positivist epistemology (science as a “true discourse on reality”; facts are trustworthy, theories are not; no science without quantitative measurement…) has been dead for ages, and some evn wonder whether it’s really been alive one day. Who said that “observations are of no value if not made for or against some view”? Wasn’t it good old Darwin, in his “triumphantly positivist” (or so the PoMos believe) XIXth century?

    In my opinion, the best refutation of all those anti-science philosophies was penned by Engels in “Ludwig Feuerbach”. Engels slammed Kant and his unknowable “thing-in-itself”, on the basis that, once we get hold of something, we use it for our purposes, it becomes a “thing-for-us”, and the fact that we can do so prove that our knowledge has some worth and corresponds to something real. But of course, modern philosophies are just as vulnreable to this criticism as Kant was.

  44. #44 jayh
    September 11, 2008

    ” When a text makes you feel really stupid, it’s probably not your fault; it’s more likely the fault of the authors and the fact that they are not thinking clearly.?

    If an author cannot explain something in concise, plain language, he does not understand it himself.

  45. #45 Don Cox
    September 11, 2008

    “If an author cannot explain something in concise, plain language, he does not understand it himself.”

    Good writing makes you feel intelligent, because it helps you to understand things that you were not clear about.

    I do wonder if we really should be fighting this post-modern woo movement. It could be a powerful agent for Natural Selection.

  46. #46 Blake Stacey
    September 11, 2008

    As the filmmaker Errol Morris once said,

    Somebody comes up to you and says, “I’m a postmodernist; I don’t care about truth; it’s subjective.” My answer is, “So it doesn’t matter who pulled the trigger?”

  47. #47 parkenf
    September 12, 2008

    Perhaps this is a central problem with post modernism, but I cannot understand the desire to remove objectivity from political discourse, never mind scientific. Do these people think that a world free of objectivity is going to be a world free of prejudice? That a world where all beliefs are given equal validity is going to be a world of tolerance and respect for difference?

    Of course the first article pulled up George W. Bush as a totem for empiricism. I remember him in his pomp having a more flexible approach to reality as the New York Times reported:

    “I had a meeting with a senior adviser to Bush. He expressed the White House’s displeasure, and then he told me something that at the time I didn’t fully comprehend — but which I now believe gets to the very heart of the Bush presidency.

    The aide said that guys like me were ‘in what we call the reality-based community,’ which he defined as people who ‘believe that solutions emerge from your judicious study of discernible reality.’

  48. #48 blf
    September 14, 2008
    A lot of it is big talk solely for the purpose of running verbal circles around the reader/listener and therefore seeming smarter.

    I’ve had exactly one person try that on me, and after a thoughtful pause asked him to take it out of the grand generalities he was using and apply it to a concrete example.

    I call this “The Feynman Method”, after the example in Surely You’re Joking, Mr Feynman! I don’t have my copy with me, but as far as I can now recall, Feynman was trying to follow some argument in topology involving a sphere by imaging he had an orange, with hilarious results.

    Anyways, I concur with D.C. and Feynman, asking–or working with–a blitherer to produce a concrete example can be very illuminating. Or at least provide some quiet.

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