Dirty rotten fascists plying their trade?
See what you think of this peer-reviewed paper by Dave Holmes in the International Journal of Evidence Based Healthcare called “Deconstructing the evidence-based discourse in health sciences: truth, power and fascism.”
Is it a hoax in the same vein as Sokal’s? You decide. Here’s a snippet from the Abstract (emphasis original):
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
Paper goes on to complain about the Cochrane Group. Now if you don’t know, these guys are ate up (this is what we Air Force guys used to say of Marines); they run all over the place waving their wee p-values at everybody and parroting the phrase “evidence-based medicine”, in much the same fashion as some atheists call themselves “Brights.”
They’re like the guy at the bar who won’t change the subject. They are annoying and too in love with quantification. Yet you are, as a doc, allowed to ignore them—mostly. Plus, the results these guys tout aren’t always wrong (or over-confident).
Well, so what. People in medicine are always bickering about what evidence counts, so much so that it’s a non-story. But now comes this charge that truth in medicine is fascism. Can the authors really be serious? Here are some quotes (all still original).
…fascism of the masses, as was practised by Hitler and Mussolini, has today been replaced by a system of microfascisms — polymorphous intolerances that are revealed in more subtle ways…
EBHS (evidence-based health sciences)…
Rather than risk being alienated from their colleagues, many scientists find themselves interpellated by hegemonic discourses and come to disregard all others…
Those who are wedded to the idea of ‘evidence’ in the health sciences maintain what is essentially a Newtonian, mechanistic world view: they tend to believe that reality is objective, which is to say that it exists, ‘out there’, absolutely independent of the human observer, and of the observer’s intentions and observations. They fondly point to ‘facts’, while they are forced to dismiss ‘values’ as somehow unscientific. For them, this reality (an ensemble of facts) corresponds to an objectively real and mechanical world…
Obvious examples here are the hysterisation of the female body and the pathologisation of homosexuality within medical discourse…
… promote the multiplicity of what Foucault describes as subjugated forms of knowledge…
…we understand such fascist logic [in EBM] as a desire to order, hierarchise, control, repress, direct and impose limits. Fascism is one of the many faces of totalitarianism — the total subjection of humanity to the political imperatives of systems whose concerns are of their own production. In light of our argument, fascism is not too strong a word because the exclusion of knowledge ensembles relies on a process that is saturated by ideology and intolerance regarding other ways of knowing…
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…
This reminds us of a famous statement by President George W Bush in light of the September 11 events: ‘Either you are with us, or you are with the terrorists’. In the context of the EBM, this absolutely polarising world view resonates vividly: embrace the EBHS or else be condemned as recklessly non-scientific.
I’m on the fence. There’s enough sanity here to fool you into thinking the insane parts are in earnest. But this in the Age of the Internet. It’s too easy to create spoofs.
I emailed Holmes and asked whether he was having us on, but received this (probably genuine) response. “Merci pour votre message. Veuillez prendre note que je serai absent du 29 février au 6 mars incl. Merci.”
Holmes is also the author of “Reversing Kristeva’s First Instance of Abjection: The Formation of Self Reconsidered” and many other similar titles, which is in favor of the current one being genuine. Plus, one of his co-authors, Rail, and the author of such papers as “Cancer’s margins and the choreography of knowledge: Toward a queer biopolitics and the mobilization of public health knowledge.”
So I’m going with genuine.
Update Just after I put this up, I received this email from Holmes. “It is a real deconstruction piece that we enjoyed writing very much!”
There you are: genuine.