Hello,
Holmes, the article author, uses qualitative designs, especially
Grounded Theory, in order to answer his research questions (see
http://www3.sympatico.ca/holmesdave/ ). These research questions include
education, nursing studies, political science, and psychology. Grounded
theory has been developed and principally used within the field of
sociology; it can be, and has been, successfully employed by people in
a variety of different disciplines. These include education, nursing
studies, political science, and to a very limited extent, psychology.
Medicine is a different field and it needs an Evidence Based approach. I
think the authors do not know what exactly is EBM; that's why they talk
about fascism (???!!!) "there is nothing people likes so little as to be
well informed...." . Hope this is an evidence based answer. Thanks for
the interesting subject.
Felice
___________________________
Dr. Felice Musicco
Hospital pharmacist IFO Roma (IRCCS)
tel. +39 06 52662047
fax +39 06 52665123
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http://www.ifo.it/IFO.3B02363D.RUN
-----Messaggio originale-----
Da: Evidence based health (EBH)
[mailto:[log in to unmask]] Per conto di Roy Poses
Inviato: mercoledì 23 agosto 2006 17.22
A: [log in to unmask]
Oggetto: Fwd: RE: Deconstructing the evidence-based discourse in health
sciences
I now have actually read the paper below, a very painful process.
The issue is not "elaborate" language, although the paper is written in
the
usual turgid post-modernist style, with all the expected bowing and
scraping to Foucault, Derrida, Lyotard, Deleuze, Guttari, etc, the
tortured
sentence structures, and the obscure ("interpellated"), and sometimes
made-up words ("hysterisation").
The paper makes some accusations which in a way are hilarious. In my
personal experience, it has been hard to get EBM related concepts into
medical education, and to get funding for EBM related scholarly work.
Yet
Holmes et al accuse EBM of being so powerful that "in a number of
faculties
of health sciences ... the dominant paradigm of EBHS [evidence-based
health
science] has achieved hegemony." I have never seen such an
institution. Instead, in most medical schools that I have seen, EBM
advocates are a minority, sometimes embattled. Holmes et al also
asserted
that EBM advocates get "institutional promotions and accolades, public
recognition, and state contracts of all kinds." Huh? Boy, I sure have
missed out, and so have many of my friends and colleagues. (To add
further
irony, Holmes at all sort of got one of those "state contracts of all
kinds." Their paper was funded by the Canadian government, through the
Canadian Institutes of Health Research- Institute of Gender and Health.)
But the paper goes from hilarious to nasty (which is why I don't believe
that it was a hoax or a parody). The paper literally accuses advocates
of
evidence based health of being fascists, and accuses the Cochrane
Collaboration of being a fascist organization, "The classification of
scientific evidence as proposed by the Cochrane Group thus constitutes
not
only a powerful mechanism of exclusion for some types of knowledge, it
also
acts as an organising structure for knowledge and a mechanism of
ideological reinforcement for the dominant scientific paradigm. In that
sense, it obeys a fascist logic." Furthermore, "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." (Read the paper, if you can stand it, to find many more
examples
beyond these quotes.)
A final thought ... This paper suggests another possible explanation of
why
academic health care institutions have been so ineffective in
challenging
some of the real threats to our professional values (of the sort we have
documented on Health Care Renewal, http://hcrenewal.blogspot.com/)
Perhaps
they have been distracted by post-modernism's incomprehensible
word-play,
cults of personality, and now its wild accusations against EBM, one of
the
only movements which tries to determine what really works in health
care,
unbiased by commercial and ideological concerns. Then the question
arises:
Has post-modernism been deliberately encouraged by some academic
leaders,
possibly those with the most severe conflicts of interest, to distract
us
from concentration and abuse of power in health care, the pervasiveness
of
conflicts of interests in health care organizations, and unethical and
even
illegal behavior by health care leaders?
>Dear All,
>well, the language is elaborate, but the ideas aren't really that
>outrageous. They seem to be saying that any group defines and promotes
>what it considers are norms for behaviour/thinking etc. and this
>inevitably excludes certain ways of doing things which can unwittingly
>have disadvantages. I think many EMBers are well aware of this. Michael
>
>
>-----Original Message-----
>From: Evidence based health (EBH) on behalf of Roy Poses
>Sent: Mon 8/21/2006 4:51 PM
>To: [log in to unmask]
>Cc:
>Subject: FW: Deconstructing the evidence-based discourse in
health
>sciences
>
>(Sent with apologies to my good friends and colleagues at the
>University of Ottawa who have been steadfastly been aiding the
>development of evidence-based medicine.... These colleagues had
>nothing to do with the paper mentioned below....)
>
>The following email has been circulating.
>
>It describes a mind-bendingly post-modern paper, published in a
>seemingly respectable health care journal, which likens proponents of
>evidence-based medicine to fascists.
>
>The paper is real, and is available on the web. The abstract below is
>representative. As best as I can tell, the paper was not a hoax of a
>satire.
>
>It seems to be an example, albeit perhaps isolated, of where the march
>of post-modernism in academia may lead....
>
>
> >>This (link to pdf below) is a recent paper which I first took to be
> >>a hoax. Apparently they are serious...
> >>
> >>Newspeak rating: Doubleplus ungood.
> >>
> >>"Deconstructing the evidence-based discourse in health sciences:
> >>truth, power and fascism"
> >>- Dave Holmes RN PhD,1 Stuart J Murray PhD,2 Amélie Perron RN
> >>PhD(cand)1 and Geneviève Rail PhD1 1 Faculty of Health Sciences,
> >>School of Nursing, University of Ottawa, Ottawa, and 2 Department of
> >>English, Ryerson University Toronto, Ontario, Canada.
> >>
>[snip]
> >>http://www.ucl.ac.uk/Pharmacology/dc-bits/holmes-deconstruction-ebhc
> >>-06.pdf
> >>Or:
> >>http://tinyurl.com/fdbry
> >>
> >>Some comments on this paper-
> >>The Quack Page (under 'worse than Barry'):
> >>http://www.ucl.ac.uk/Pharmacology/dc-bits/quack.html#holmes1
> >>badscience.net:
> >>http://www.badscience.net/?p=277
> >
>
Roy M. Poses MD
Clinical Associate Professor
Brown University School of Medicine
<[log in to unmask]>
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