Sunday, August 13, 2006

Truth, Power, Fascism and Silly Buggers

When I talk to people in the natural sciences and engineering about post-modern hyper-relativism, they often stare at me in disbelief. "Knowledge is 100% socially constructed? Airplanes can fly just because we've all agreed to believe that they can? What are these people on, and where can I get some?!".

But every now and then a few postmods manage to break out of the humanities wing and publish in real science journals. Dear non-humanities Reader, a golden opportunity to find out what this is all about has just come on-line as a pre-print of a paper in the September issue of the International Journal of Evidence-based Healthcare.

Ottawa-based Foucaultian nursing researcher Dave Holmes and three co-authors have written a paper with the telling title "Deconstructing the evidence-based discourse in health sciences: truth, power and fascism". Read it here, if you can stomach it.
"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."
The co-authors are the rhetoric PhD editor of media studies e-journal Mediatropes, a doctoral student in medical ethics and a professor who did her PhD on kinesiology and describes herself as a "feminist critic of body-related institutions (e.g., sport, cultural media, health systems) [who] favours feminist cultural studies, poststructuralist and postcolonial approaches." Quite a dream team!

Alun alerted me to this thing, and scathing blogger commentary is here and here. Mind you, all criticism of the paper in question is of course just fascistic mind control by the establishment's lackeys.

Update 14 August: Says Dan Larhammar: "The International Journal of Evidence-based Healthcare has only been issued since 2003. It is not yet on the ISI Web of Knowledge where journal citation reports are collated for the calculation of citation impact." So blogger criticism is giving an obscure paper unexpected exposure.

Update 28 August: the kinesiologist among the co-authors has not worked with the quack therapy applied kinesiology. Says Wikipedia, "Kinesiology encompasses human anatomy, physiology, neuroscience, biochemistry, biomechanics, exercise psychology and sociology of sport."

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Anonymous mugabe said...

It's easy to take pot shots at people namedropping Deleuze and Guattari, but having skimmed the entire piece, I really don't see the big problem. Seems to me the authors are merely questioning the uncompromising "Either you are with us, or you are with the terrorists"-hegemony within the modern medicine paradigm. Mind you, medicine is not an exact science like archaeology.

Then, of course we have the best medical science ever. As we did in the days of bile, phlegm and blood.

13 August, 2006 12:15  
Blogger Alun said...

I think one problem is that their same criticisms could also be delivered with even more force against their own argument. The Cochrane Institute which that criticise hasn't declared itself 'at war' with postmodernists. What it has done is said if you wish to enter our database then your work must conform to these rules. If it doesn't there are other databases. These authors appear to be committed to forcing the Cochrane Institute and others to do things their way.

They also use language which is clearly defined and understood by professionals within their field. This paper's authors on the other hand are imposing definitions from elsewhere and dropping them into a nursing journal. Hence the opening where they tell the reader "your definition of fascism is no good - this authority defines fascism". This is the very colonisation they claim to deplore.

Their work name-drops from an approved lexicon and if you disagree with them you're on the side of the microfascists.

Hence this paper is bad because it is self-refuting. If you're in favour of postmodernist readings of society then it's bad because it merely works to confirm stereotypes and prejudices rather than expose people to any novel thought.

This is why it's so easy to take pot shots at people namedropping Deleuze and Guattari.

13 August, 2006 13:16  
Anonymous mugabe said...

Criticism seems to be strictly against the form of the paper, with people quoting the famous Sokal spoof, and less concerned with the actual contents. Mentioning Kuhn makes sense when discussing paradigms. Quoting Deleuze when it comes to hegemony of thought does as well. One of the problems is probably that they're challenging something called "Evidence-based Health-care", which by definition is untouchable. Can't argue with evidence, now, can you?

The paper might be badly written, overly self-indulgent or whatever, but it's hardly a call to end rational thought. Rather the opposite, perhaps, albeit contrived.

As user "antirealist" pithily sums it up in a comment on the board:

There is a critique to be made of EBM and its institutional and political influence, but this sophomoric paper isn't it.

13 August, 2006 14:35  
Blogger Martin said...

C'mon, Mugabe, you must be kidding. Anyone who uses the phrase "alternative forms of knowledge" should be given a floor job in a sewage processing plant. Not to mention the cute stunt of defining the word "fascist" in a novel way just to be able to use it about your scholarly opponents.

Medicine, unlike archaeology, is an exact science. Like archaeology, however, it deals with extremely complex systems where it's very hard to isolate individual parameters and discern their roles in the system.

13 August, 2006 21:04  
Blogger Martin said...

Mugabe, are we using different definitons of the words "evidence based"? To me it means the opposite of "we do this because we have a hunch it might work or because our guru told us to". It means "let's check out if this really works reliably".

13 August, 2006 21:24  
Anonymous Anonymous said...

Ottawa-based Foucaultian nursing researcher Dave Holmes. . .

Oh gawd, and he teaches at my alma mater too! U of Zero, what's become of you?

14 August, 2006 13:05  
Blogger Orac said...


You know I'm going to have to read this paper and perhaps take a shot at it.

14 August, 2006 13:47  
Blogger Martin said...

Well, Holmes et al. are sure getting some exposure! Which may be exactly what they wanted. International Journal of Evidence-based Healthcare is an obscure Canadian journal about nursing. It had only about 860 Google hits before this thing started.

14 August, 2006 13:55  
Blogger Ben said...

As well as Pharyngula you should know there's also "Some of you might enjoy this absolute cracker" in BadScience


14 August, 2006 21:24  
Blogger Martin said...

Yep, BadScience was first with this story and there's a link to it in my entry.

15 August, 2006 07:45  
Anonymous Anonymous said...

Medical science, like all science, is not either/or as some seem to think. The whole idea of evidence based processes is that one CHANGES his or her actions and treatments based on the changing evidence: "spirits don't cause diarrhea,, micro-organisms do? OK, lets use different treatments that work and are predictable and reproducable." Data/evidence, reproducability, predictabliity! I'd like to hear a better system. If this is hegemony, I'll take it.
Some will just never get it and want the world to be different than it is.

15 August, 2006 19:35  
Blogger Temboo said...

You're being a little hysterical here, Sobrius ... I know quite a few people who are very enamored of postmodern thought and every one of them is also very much in favor of science, empiricism, etc. It's a silly straw man to talk of people who think airplanes only fly because of social agreement or that everything is 100% hyper-relative. I mean, Thomas Kuhn, a favorite among those who study the philosophy of science from a postmodern perspective, was himself a physicist, and was not in any way suggesting that science is completely arbitrary and relative.

What's really unfortunate is people who overreact and totally misinterpret and misrepresent postmodern thought, confusing it with some kind of infantile nihilistic hyper-relativism, and don't bother to actually read or understand what they're really saying, which is a lot less extreme than that, and in fact in many ways very sober and sensible. The basic critique isn't that everything is absolutely equivalent and all forms of knowledge are equally valid, but that there isn't and shouldn't be a single metric by which truth or validity is established. To criticize the notion of a single standard isn't to suggest that all standards are equally good, or that empiricism is invalid, etc.

I actually went ahead and read this paper and as far as I can tell it doesn't really say much of anything beyond "other standards besides RCT-based studies should be considered for evaluating the validity of medical practices." Their claim is that even in the scientific literature, 98% of studies don't comform to Cochrane standards --- not being in medicine myself I have no way of evaluating that claim, but if true it might be a point worth considering.

I don't think the paper is really saying much, frankly, it's a pretty weak paper -- for example they don't bother giving an example of even one alternative paradigm for evaluating the efficacy of health care practices --- in this regard the paper is nearly worthless. But to hyperventilate and scream that postmodernists are out to totally destroy science --- that's not only silly but intellectually lazy. Go out and read and think about what they're actually saying, don't just repeat the hyperbolic claims of people who have next to no understanding of the field.

25 August, 2006 01:29  
Blogger Martin said...

If post-mod thought is indeed misinterpreted and misrepresented, then it is most likely because it is presented in such an impenetrable jargon. To my mind, that is an infantile way of expressing one's thoughts.

My "hyperbolic claims" are actually my own: I have been debating post-modernists in archaeology since the early 90s.

As for a single metric of truth and falsehood, well, that's the basic bone of contention. Rationalists such as myself accept only one type of truth. There is or is not milk in the fridge. Women are or are not repressed by patriarchal society. Elvis lives, or not. All else is muddled thinking.

I'm glad, though, that we agree about the quality of Holmes et al. 2006.

25 August, 2006 14:42  
Anonymous mugabe said...

Martin wrote:
Anyone who uses the phrase "alternative forms of knowledge" should be given a floor job in a sewage processing plant.

1. Knowledge is not necessarily true.
2. It seems the authors are challenging the EBM people's alleged monopoly on knowledge, consequently calling for the acceptance of "alternative forms".

As for the term "evidence-based", medicine is, as you elegantly put it, "exact", but deals with "extremely complex systems where it's very hard to isolate individual parameters and discern their roles in the system." Hence, the "evidence" at hand might be two unknown side-effects interacting. Is this still knowledge?

27 August, 2006 00:28  
Blogger Martin said...

Knowledge is commonly defined as belief that is well-founded and true.

Scientific knowledge already has built-in leeway for revision. Here, knowledge is seen as provisional. It's accepted until new evidence comes along that disproves it or shows the truth to be more complicated than formerly believed. But when someone claims knowledge, or to change your mind, you should demand evidence.

27 August, 2006 08:22  
Anonymous Anonymous said...

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25 October, 2006 01:39  
Blogger Martin said...

That's "Madam you to Hell" to you, buster.

25 October, 2006 07:40  

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