Dear Owen,
thank you for the this last comment. Just one point. By the way you say
that "... this in military interventions
> today, on apparent humanitarian grounds, that claim to have precision
> bombing technolgies that achieve effects on their intended target, but
> fail to value, or mention, the collateral harms: deaths of increasing
> numbers of civilians..."
It is not correct. By the best estimates we have, the civilians to
militants in human wars die as 1:1 for centuries. Claims that pricesion
weapon is not precision in sense it kills more civilians are not
supported y evidence.
VVV
On 2018-11-03 14:35, Owen Dempsey wrote:
> To respond to Ben's question, I have tried to be succinct.
>
> Values and beliefs that guide practice:
>
> It might not be made explicit very often but the theoretical basis for
> EBM, broadly speaking, is logical empiricism (Howick, 2011), and this
> is based on the assumption that the human can know the world and him or
> herself through emprical observation, and therefore can be fully self
> aware and therefore capable of making fully free and independent
> decisions. However, by contrast, our beliefs are constructed for us,
> through our ‘reason and imagination’ (Henriques, 1984) within limits set
> by capitalist relations of production etc. so that we all fetishise
> commodities for their apparent power to generate surplus wealth and
> life. This makes us all radically uncertain of our mortality (Dempsey,
> 2018, ch 12).
>
> Overdiagnosis
>
> Anticipatory tests try to achieve the impossible: to specify that point
> of difference between the normal and the pathological, thereby leading
> to inevitable over-diagnosis. Over-diagnosis is never personally
> experienced as such and so can never be adequately valued as a
> personally relevant harm. So this harm can never be adequately
> represented to patients as a harm to be valued as harm. This makes the
> marketing of such tests anti-democratic (Dempsey, 2018, pp 29-32).
>
> Science and power
>
> Mainstream institutions exercise tremendous power through a combination
> of a) pragmatist science and b) political and market imperatives to
> innovate and increase production of diagnosed and therefore treatable
> patients. It is pragmatist science (and not logical empiricism) that
> determines the praxis of EBM. The difference being that pragmatist
> science (James, 1996), a) treats elite impressions of the value of
> intended effects as if they are empirical facts; and b) does not value
> collateral harms as harms.
>
> (We can also, by way of analogy, see this in military interventions
> today, on apparent humanitarian grounds, that claim to have precision
> bombing technolgies that achieve effects on their intended target, but
> fail to value, or mention, the collateral harms: deaths of increasing
> numbers of civilians).
>
...
--
\/.\/.\/.
Vasiliy V. Vlassov, MD
President, Society for Evidence Based Medicine, osdm.org
Professor, National Research University Higher School of Economics
e-mail: vlassov[a t]cochrane.ru
Web page https://www.hse.ru/en/org/persons/14527416
snail mail: P.O.Box 13 Moscow 109451 Russia
Phone Russia +7(965)2511021
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