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.