Dear All,
indeed the paper was not a hoax, and was published in a blinded peer reviewed
journal, although I must confess I am not sure if the author was aware of the
nature of the journal, and its clearly pro-evidence based health care focus!

However, it has probably served some use in that these sorts of views exist,
need to be aired and explored. It does give the ebm community a great
opportunity to review its position, and to develop solid arguments, as you are
aware, there was a response to the paper that was published with it, and I do
hope that some of the well developed arguements put forward in this forum are
expanded upon and published in response to this paper.

regards,
Craig


Quoting Felice Musicco <[log in to unmask]>:

> 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
> email [log in to unmask]
>
> 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]>
>