2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003

Medicine’s Focus on Evidence is Not “Fascist”
August 21, 2006
Trevor Butterworth
A call to arms against a sea of “evidence-based logic” flounders in bad faith

Medicine’s focus on evidence is “fascistic,” according to a paper in the September 2006 ( pp. 180-186) issue of the International Journal of Evidence-based Healthcare.

No, we’re not making this up. And we are not sure whether to be grateful to the doctor-philosopher-blogger and Guardian columnist Ben Goldacre for bringing this to our attention; but it does usefully encapsulate why those of us who follow in the footsteps of Francis Bacon should not confine our criticism of scientific ignorance (and thus a fundamental philosophical ignorance) to the political right.

The authors of “Deconstructing the evidence-based discourse in health sciences: truth, power and fascism” draw on

“…the work of the late French philosophers Deleuze and Guattari… 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.”

You may need to read this twice to realize the extraordinary claim the authors are making: medicine should not be guided by evidence as evidence is presently defined in science.

“Critical intellectuals should work towards the creation of a space of freedom (of thought), and as such, they constitute a concrete threat to the current scientific order in EBHS and the health sciences as a whole. It is fair to assert that the critical intellectuals are at ‘war’ with those who have no regards other than for an evidence-based logic. The war metaphor speaks to the ‘critical and theoretical revolt’ that is needed to disrupt and resist the fascist order of scientific knowledge development.

The evidence-based enterprise invented by the Cochrane Group has captivated our thinking for too long, creating for itself an enchanting image that reaches out to researchers and scholars. However, in the name of efficiency, effectiveness and convenience, it simplistically supplants all heterogeneous thinking with a singular and totalising ideology.

The all-embracing economy of such ideology lends the Cochrane Group’s disciples a profound sense of entitlement, what they take as a universal right to control the scientific agenda. By a so-called scientific consensus, this ‘regime of truth’ ostracises those with ‘deviant’ forms of knowledge, labelling them as rebels and rejecting their work as scientifically unsound.”

Only health professionals writing in total ignorance of modern epistemology could write this sophomoric pastiche of philosophical inquiry (and in case you think were being microfascistic here, we’ve read our Deleuze and Guattari too).

There is ample freedom within literature departments to express such ideas (although they are a lot less fashionable than they used to be); but in a clinical situation – such as the ER – a “regime of truth” that justifies itself in terms of clinical trials, deduction and induction, cause and effect, and so forth, is the best guarantor of exiting the E.R. alive – or in better shape than upon entering. Evidence may indeed be “enchanting,” but that doesn’t make scientific rigor in medicine the equivalent of magic.

And what else could magic be but the kind of “deviant form of knowledge” that the authors bemoan is being oppressed by those who favor “evidence-based logic?”

This kind of blasé, jargon-driven, third-rate critical thinking tends to fall like manna to those who cannot bear to endorse anything that’s a product of the Enlightenment – save those attempts to destroy it from within.

And yet, one presumes that the authors of this paper – much like those who will defend its contents – engage in a form of life that explicitly contradicts the critical principles they presently avow: they wash their hands after using the bathroom, they boil water, they turn ignition keys on machines that are driven by the principles of internal combustion (cars) and not by the will to power or supernatural force, they balance their checkbooks, look both ways before crossing the road, cook chicken thoroughly – and expect the earth to keep revolving around the sun.

Even if they do all these things merely because they hold them as contingent beliefs, they still hold them as contingent beliefs for good reasons: if the bubbles don’t appear in the water, the potato will not cook.

Why is it acceptable to rely, implicitly, on “evidence-based logic” to drive to the supermarket, but not to treat cancer? Why is the Cochrane Collaboration a “fascistic” organization and not the Meterological Office – or are the authors also advocating a “war” on contemporary weather forecasting? (The Cochrane Collaboration “produces and disseminates systematic reviews of healthcare interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions,” according to their website.)

If the authors are interested in European intellectual history, they should reflect on what Jean Paul Sartre meant by “bad faith.”

Fortunately, it is doubtful whether any doctor or medical professional has the time or inclination to read “Deconstructing the evidence-based discourse in health sciences: truth, power and fascism” (those we contacted for comment were uniformly derisive).

But the paper is a timely reminder that science doesn’t just have enemies on the right of the political spectrum.

"Heaven forbid we should actually want to establish that our medicine does something before administering it," says Dr. Frank.

"Anyone who cites Deleuze and Guattari as their main references and uses “fascist” as an adjective to describe ” evidence-based [science]” is on a hiding to nothing," psybertron asks.

"...a teenage screed dressed up in intellectual jargon," says Polite Company.

"...if rational criticism is impossible then competing ideas cannot be assessed, conflicts between them cannot be resolved without recourse to force or authoritarianism, and most importantly, immune to criticism these ideas become incorrigible, and thus transform into the most dangerous of all things: dogma," says Calamus (who examines the intellectual antecedents to the theories in the paper).

"Would you let Foucault or Derrida treat your cancer?" asks Pharyngula.

"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?!" says Salto Sobrius.