Thanks Ben
I will comment on your article when I have read it properly, and take it up as another thread.
Right now I want to make a few comments on the article "Method as argument: boundary work in evidence-based medicine" by Diane Derkatch.
My plan was to comment on each of the articles in the series in Social Epistemology, but my enthusiasm is waning as I weigh up the time/benefit ratio.
I want to make just three points about Diane Derkatch's paper, which haven't been made by others (or by myself in previous posts).
"Diane Derkatch is a doctoral candidate in English at the University of British Columbia, where she studies rhetoric of science, health and medicine."
Kerkatch says "the notion of efficacy can function as a rhetorically mobile boundary object that can redefine the very terms of debate". And elaborates: " measures intended to ensure objectivity can be actively manipulated to produce desired results; in such circumstances,
efficacy takes on new meaning, literally, because it comes to mean whatever the triallists
engineer it to mean."
1) Tu quoque
I shall ignore the straw man rhetoric (this was discussed by Frances Gardner).
Kerkatch, Grossman, and I suspect the other authors in this series, engineer the meaning of EBM to fit the purposes of their argument. Their concept of EBM is not the concept that I have learned from the people who develop and teach EBM. To paraphrase Kerkatch, the notion of EBM can function as a rhetorically mobile boundary object that can redefine the very terms of debate.
Kerkatch thus scores an own goal by inviting a tu quoque (you too) rhetorical response.
2) Non sequitur
Kerkatch uses an example of an RCT of acupuncture to complain that "Traditional acupuncture theory is wholly absent in the report and the authors only gesture toward the intervention's potential mechanism in the Discussion, where they cite several biochemical possibilities. The absence of any underlying theory in the Methods section makes the authors' careful description of the needle manipulation protocol seem strangely undermotivated."
But, she does not explain why this matters. There is a good reason why RCTs do not discuss theory in their methods sections: they are designed to answer the question "Does it work?", not the question "How does it work?".
For example, the design of an RCT to assess homeopathy for some condition would not change depending on whether the homeopath believed in the "memory of water" theory or the "quantum entanglement" theory.
So, the complaint that theory is absent from methods section is a non sequitur.
3) Evidence-lite
Kerkatch's aim is to "frame the problem of method as a fundamentally rhetorical problem ...".
There are about 67 citations in the list of references. Two of these are RCTs. In one of the RCTs the bit in the methods section that describes how acupuncture needles were inserted is quoted.
If I were to write a paper on the rhetoric of the metaphysical_poets, and say that Andrew Marvell and John Donne were metaphysical poets, and quote one line of "Death be not proud", I would not have demonstrated much knowledge and understanding of their poetry and rhetoric, even if I cited 65 eminent critics.
Thankfully I haven't the time to go on any further, other than to remark that the rhetoric of rhetorical analysis can illuminate some of its deficiencies.
Michael
-----Original Message-----
From: Djulbegovic, Benjamin [mailto:[log in to unmask]]
Sent: 05 January 2009 22:19
To: Michael Power; [log in to unmask]
Subject: RE: Fw: Special Issue:Evidence in Evidence-Based Medicine Fw: Social Epistemology - informaworld
Btw, here is our response to John Ioannidis' article you cited...
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