Friday, August 18, 2006

Fighting evidence-based medicine with postmodernist bollocks

"Microfascists unite! You have nothing to lose but your evidence-based science!" That's the mildly paraphrased call from three postmodernist academics who have published (in what was once a fairly reputable journal) a deconstructionist attack on reason and evidence in medicine. Excerpt:
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 arena.

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.
[Hat tips Stephen Hicks and Bad Science -- check out Bad Science's 'Postmodernist Bollocks' if you want a really serious laugh, and Hick's 'Explaining Postmodernism' if you want to understand why such bollocks is fashionable.)]

It would be nice to think this was a joke, much like the celebrated hoax on deconstructionist idiots perpetrated by physicist Alain Sokal (story on the 'Sokal Hoax' here; Sokal's website here; Sokal's excellent book eviscerating fashionable postmodernist nonsense here). However, given that such bollocks is still all-pervasive in too much of academia, the move to disintegrate knowledge and to 'un-know' what we already know seems to be continuing apace.

LINKS: Deconstructing the evidence-based discourse in health sciences: truth, power and fascism - Bad Science
Socal hoax - Wikipedia
Alan Sokal's website (includes much more detail of the hoax, including the reasons why and the reactions to)

RELATED: Health, Science, Postmodernism, Nonsense

Labels: ,

9 Comments:

Blogger libertyscott said...

I remember being peddled this snake oil at university before I really knew better - it scared me off doing my MA.

8/18/2006 08:53:00 am  
Blogger HORansome said...

There is a problem, practically, with EBM, in that some medicial professionals (some, not all) use evidence-based medicine to the exclusion of experience. You tend to find this in poorly funded help clinics where GPs either don't have the time (or can't be bothered) to consult with the patient and simply prescribe the 'generic' cure. EBM is a complimentary practice; clinical studies taken in conjunction with good consultation based upon experience is the way to go; EBM by itself is a dangerous practice. There's a growing literature on this and I was asked to include the debate in a course for the second years at the Med School last year.

None of which justifies this post-modernist (one would hope) piss-take of a criticism. Sounds like someone had the germ of a good idea (show that EBM in isolation is dangerous) but ran too far with it.

8/18/2006 03:05:00 pm  
Anonymous Falafulu Fisi said...

HORansome said...
[There is a problem, practically, with EBM, in that some medicial professionals (some, not all) use evidence-based medicine to the exclusion of experience.]

Sorry, I don't follow you here, can you give an example? To my understanding, anything evidence-based has already engulfed knowledge from experience. As in mathematical logic, it can be stated that experience (E) is a subset of Evidence based (EBM). I would like to know a single example if you can quote one of a decision that excludes experience thus solely relying on EBM.

horansome said...
[You tend to find this in poorly funded help clinics where GPs either don't have the time (or can't be bothered) to consult with the patient and simply prescribe the 'generic' cure]

I am not a medical doctor, but a doctor ALWAYS consults the patient to figure out what possible treatment to prescribe. If a doctor does not do this (an obligation) he/she can be reported to their medical council (or whatever disciplinary body that oversees that). I have never heard any GP, that the patient appeared at the door, and then he reaches to the pen & paper to prescribe treatment without even asking a single question to the patient to establish a possible cause. Have you heard of such cases? If you have, then please report it to the medical authorities; as such doctor is dangerous to practice in the community.

horansome said...
[EBM is a complimentary practice]

No, I disagree here. EBM is the mainstream practice and not complementary practice. If you say that it is complementary, then complementary to what? Do you think that it is complementary to homeopathy, naturopathy or psychic healing?

horansome said...
[clinical studies taken in conjunction with good consultation based upon experience is the way to go]

I thought that this is the norm? Experienced is the easiest knowledge to verify. It is the first concept to be tested by researchers, because they already have a clue to what to test.

horansome said...
[EBM by itself is a dangerous practice.]

What a ridiculous comment? I am not sure, whether you are from NZ or not, but do you remember a little boy who was a cancer sufferer from Southland called Liam Williams-Holloway , 1998? It was a sad story. The parents of the boy took the boy off from the chemotherapy treatment program that he was undergoing to seek alternative treatment. The health authorities filed charge against the parents for medical negligence. There were a number of sympathisers around the country during that time including proponents of alternative medicine (I assume that this is the sort of medicine you support) helped the parents when they were running from the law. They took the boy to an alternative treatment with a so-called 'quantum-booster' that suppose to vibrate and transmit it to the body of the sufferer to re-align DNA and rid of the disease. This treatment never worked, then the parents took the boy to an alternative medicine clinic in Mexico. Guest what, the boy succumbed to the disease and died. The physician who treated the boy at Southland hospital before the parents took their son off the chemo treatment spoke out that if the boy had continued on with the treatment, there would have been a high chance that he would have been cured of the cancer. It is a sad story, because when faith overrides reason (evidence) then disaster happens. There is nothing in medicine called 100%, but there is always something called high success rates (could be 60%, 70% or more - depends on the treatment used). The chemo machines available at hospital have been designed by physicists, electronic engineers, software engineers, including medical doctors to consult with the engineers on the physics of the machine relate to the biology of the human tissue. They then conduct test (could be years) if the success rate of treatment using such machines is reasonable (60% or more), before any approval for commercial use. So, knowledge was used to design the machines rather than a psychic's imagination.

Alternative medicine is a movement spearheaded by some scientists who wanted their distorted view pushed to the public. Science is just science, period. There is no such thing as alternative science and mainstream science. I can't imagine such principle as 'Mainstream Newton 2nd law of motions' and 'Alternative Newton 2nd law of motions'. 'Newton 2nd law of motions' is just 'Newton 2nd law of motions’, there is no mainstream or alternative version of the theory. In that case, it is evidence-based. There is evidence to the theory. If you take away evidence to any scientific investigation, then you are no better than the homeopath that mixes sugar pills (pure water) that does not contain any active ingredient and charge you for it (pure water) and claim to cure this or that. The world & the advancement of civilization depend on evidence-based science whether it is medicine, physics, chemistry, psychology, economics, engineering, etc. Whether you accept it or not, it is facts of life, ‘Evidence-Based’.

8/18/2006 07:41:00 pm  
Blogger HORansome said...

Falafulu Fisi, I refer you to:

Giacomini, Mita K, ‘The rocky road: qualitative research as evidence’ (editorial) in ACP Journal Club, Volume 134(1), 2001, pp. A-11-A-13

Haynes, R. Brian, ‘What kind of evidence is that Evidence-Based Medicine advocates want health care providers and consumers to pay attention to?’ in BMC Health Services, Volume 2, Number 3, 2002

Both of which give a good overview of current problems with the implementation of EBM in clinical practice. I assume from your comments that you do not understand the role of EBM (evidence-based medicine is survey-based, not consult-based) in one-to-one patient care and these two, easy to read, articles, should be of help.

As for your diatribe against alternative therapy; you are preaching not just to the choir but the choirmaster.

8/19/2006 11:31:00 am  
Anonymous Falafulu Fisi said...

HORansome said...
#1)[Giacomini, Mita K, ‘The rocky road: qualitative research as evidence’ (editorial) in ACP Journal Club, Volume 134(1), 2001, pp. A-11-A-13]

#2)[Haynes, R. Brian, ‘What kind of evidence is that Evidence-Based Medicine advocates want health care providers and consumers to pay attention to?’ in BMC Health Services, Volume 2, Number 3, 2002]

I don't get access to those papers as I am not a medical doctor. However, I request that if you have read them or get access to them, then please cut & paste the bits you think that are going to invalidate my argument so that I can respond to that later. I will then try to debunk claims by those authors as they might be alarmists like Professor Mann (pro-global warming, hockey-stick model author which has now been disputed). The reason, I request that you posted some bits of the articles (not all), is that you yourself could be easily deceived by alarmists counter argument to the way statistics is being used for EBM. I am not going to be deceived easily where my main domain as a specialist in advanced statistics & mathematical computing where I can pick out easily if the authors criticism of statistical methods used for EBM is fair, irrelevant or just being alarmists for the sake of drawing their names to the attention of the medical community.

HORansome said...
[I assume from your comments that you do not understand the role of EBM (evidence-based medicine is survey-based, not consult-based) in one-to-one patient care and these two, easy to read, articles, should be of help]

What a load of bullshit. As a data analyst, you collect data. The data can be from survey-based or consult-based. The next step is to formulate a hypothesis, then proceed to statistical testing. Data can be pre-processed first to take out outliers (possibly errors) and fill in the missing values (possibly not recorded by the conductor during the experiment) by using interpolation techniques (or by some other methods and algorithms where there are tons of them available from statistical literatures). If the data distribution is skewed, then normalize it first (transform into Gaussian distribution - normal curve), because it is easier to 'infer' conclusions from the transformed data rather than the original skewed data. After all those steps, then comes the statistical test. There are tons of tests available (Wilcoxon test, Sign test, Z test, T test, Jarque-Bera test, Kolmogorov-Smirnov test, Lilliefors test, ANOVA test, Friedman's test, and so forth) and again it depends on the conductor to pick out a specific algorithm for the test as to validate his/her hypothesis. You just don't pick a test randomly. You pick one based on the hypothesis that you have formulated. My point here is that data used for evidence hypothesis testing is indiscriminate whether it was collected via a survey or collected via consultant-based. To consult someone in a one-to-one situation you have to talk to that patient, then you have to take note and record every answer you get. For any physician to not record any data during an interview with a patient for diagnosis is an incompetent one and should be reported to the medical authorities. At the end of the diagnosis, the physician has some data recorded. The data is then used for analysis. The outcome of the analysis is used to determine a certain hypothesis. The hypothesis is validated (statistical significant) or rejected (insignificant), and you call that EVIDENCE.

HORansome said...
[As for your diatribe against alternative therapy; you are preaching not just to the choir but the choirmaster.]
Show me the evidence. Oh, God, please don't revert to statistics to validate alternative therapy, as has been shown time & time again that statistical tests of the outcome of alternative treatments is no better than placebo effect. That means it is bullshit. I assume that you must hate the Penn & Teller Bullshit show as it reveals unsubstantiated claims coming from alternative medicine as no facts to them. I have seen many arguments from the proponents of alternative medicine in criticising the way statistical methods used for EBM where they said it can’t be used to test alternative medicine treatment. When those proponents are pressed to come up with a hypothesis and a statistical test or statistical methodology, they go silent. Their main criticism is that statistical analysis can’t be applied to their practice. This is pure bullshit, because they want to avoid, being regarded as bullshit practice, since the same scientific tests applied to their treatment show no result of improvement at all. I can point you out to some web sites that homeopaths claim that statistics can’t be applied to testing to see if their treatment is valid or not. So, please show me evidence that alternative medicine work. Don’t go and collect anecdotal evidence because that is not a verified scientific statistical test.

8/19/2006 01:12:00 pm  
Blogger PC said...

FF, I think you might be punching the wrong man here.

When HOR said "As for your diatribe against alternative therapy; you are preaching not just to the choir but the choirmaster, I suspect he was saysing he's in the forefront of those attacking them.

8/19/2006 01:44:00 pm  
Anonymous Falafulu Fisi said...

PC said...
[FF, I think you might be punching the wrong man here.]

Ok, my appology to HORansome then as we are on the same boat on that issue. HORansome, please if you could cut & paste the disputes in those publications you quoted, because it would help me determine if the authors are correct in their criticism of the EMB methodology or not.

Cheers.

8/19/2006 02:13:00 pm  
Blogger HORansome said...

Both of those articles would be available within any decent library system or via interloan. Both are written by reputable medical professionals and you will find that your characterisation of EBM is flawed (which is, in itself, is a common misconception; Evidence-based Medicine is as accurate a name to the practice as the Big Bang Theory (i.e. they are misnomers)). I shall not post snippets of these articles; for one thing selective citation will never be as good as a full understanding of the text and for another I really cannot be bothered having to transcribe from my hardcopies. As an academic I do not really want to waste what little leisure time I get transcribing; I do enough of that when writing articles and preparing lectures.

8/19/2006 02:50:00 pm  
Anonymous Falafulu Fisi said...

Out of all the alternative medicine, I have to say that homeopathy is the most ridiculous of them all. I frequently visit the HealthFraud and Quackwatch web sites to find new update on homeopathy ridiculous claims. Here is an article on Quackwatch on homeopathy.

"Homeopathy: The Ultimate Fake"
http://www.quackwatch.org/01QuackeryRelatedTopics/homeo.html


The following is from Unintelligent Design web site.

" Don't Drink the Water......"
http://theclayexperience.blogspot.com/2005/09/dont-drink-water.html

I challenged the President (Bruce Barwell) of the NZ Homeopathic Society from Mt. Eden that I wanted to debate with their community members about the scientific validity of homeopathy. Their president replied back to me, saying that they have heard all this anti-homeopathy bashing before. Although my challenged was turned down, he offered to send me some proofs to read. Guess what he sent me? Homoeopathica journal (6), which is their own publication. I thought I was reading some 6-year-old scribbles. Of course it was not in handwriting, but the poor quality of the publication as to be called a journal. It is not peer review journal though. It is published for the local audience. It is more like a cult following. Everything is all anecdotal. Patients were interviewed by different authors for each article in all the volumes, where there were 6 given to me. The so-called evidence promised to me by Bruce from the publications, were based on provings (term for homeopathy treatment) done on some homeopathic patients. No, randomised control trial at all. To be honest, the publications were like child-play. I didn't know why I was reading them for. I only tried 2, and ditched all to the rubbish bin. Try looking at some of the articles posted on their website by clicking on the 'Editorial' link. It is a laugh to read about the ridiculous claims made over there.

"New Zealand Homoeopathic Society"
http://www.homoeopathica.org.nz/index.html


While the government is cutting the science research funding programs at our Universities, they turned around and fund pseudo-science degree programs in homeopathy. Yes, AUT is teaching a degree program in homeopathy. AUT is the most disadvantaged out of all our Universities by the new government funding which is based on research, and they (AUT) are allocating money for teaching pseudo-science? I don't get it. I suspect one reason why AUT is doing degree programs in homeopathy is to get 'bums on seats'. They must kill those useless degree programs and divert that money to their newly established science & technology faculty (departments), which is still trying to build itself from scratch. They should leave homeopathy to private institutions to teach, as taxpayer’s money should not be used to fund pseudo-science at all. There are more important courses to fund, which is demanded my industry rather than funding pseudo-science.

I read in the Herald, that the Auckland City Council gave about $2,500 community funding to a group who claim that they can have conversation with the dead. The aim of this group when they applied for the community funding was that they wanted to use it to apply for an NZQA approved course in conversation with the dead. Jesus, has the Auckland City Council gone insane for approving that? Man, imagine if NZQA approves a B.Sc degree in ‘Conversation with the dead’ or ‘Consulting with the dead’, if this group’s application is accepted. Despite the Auckland-wide uproar on the rising rates, the Council approves funding to help the application of a group for a degree program (BA or B.Sc perhaps) in bullshit.

8/20/2006 12:53:00 am  

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