Roy, thanks for bring this paper to our attention.
I wonder how the authors (and their supporters) would feel sitting in a court where the only "evidence" allowed was accusations and testimony by their enemies. This is how fascism works, and this is how Dave Holmes RN PhD, Stuart J Murray PhD, Amélie Perron RN, PhD(cand) and Geneviève Rail PhD judge evidence-based healthcare.
To justify this assertion I shall deconstruct one of their deconstructions. They say
"For example, one of the requirements of the Cochrane database is that acceptable research must be based on the RCT design; all other research, which constitutes 98% of the literature, is deemed scientifically imperfect."
The supporting citation is not to the Cochrane Library or Manual of systematic reviews, but to "Traynor M. The oil crisis, risk and evidence-based practice. Nurs Inq 2002; 9: 162-9." By relying on bigoted and uninformed testimony rather than evidence they demonstrate a fascist disdain for the truth. They also demonstrate a common psychological failing: seeing your own faults magnified in other people.
Similarly, to talk about "the Cochrane database" in this way demonstrates their ignorance of what the Cochrane Collaboration does. The Cochrane Library has about 6 databases or registers (counting is problematic because it is difficult to tell from the website whether a "product" is a separate database or a filtered view of a larger database). If they wanted to refer to the register of controlled trials they should have said so. But, if they had done this it would have exposed the wooliness of thinking in the accusation that 98% of the scientific literature is imperfect.
Putting in the number "98%" demonstrates another common psychological failing: when you are insecure, throw in a few pseudofacts to cover your ignorance. Have they (or anyone else) tried to count "all other research"?
My final deconstruction (I could go on, but it would be pointless) is to note the scope of the accusation that "98% of the literature is deemed scientifically imperfect". Holmes et al conveniently do not answer the question "Imperfect for what?". If it had occurred to them that this is an important detail they would have soon realized that science has a large toolbox of study methods, and good scientists use the appropriate tool for the job. Only a deconstructionist could imagine that an RCT would be used to assess the management of avian flu in a particular country. An observational study is needed.
Deconstructionists avoid details and facts because they impair their ability to insinuate, slur and slander, and because this might highlight the absence of constructive criticism. This is a pity, because there is much room for improvement in the aspirations, rhetoric and practice of evidence-based healthcare. It is a double pity because people who are aware of the shortcomings of evidence-based healthcare too easily accept fascist-style judgements about evidence-based healthcare.
Deconstructionism is fascist surrealism.
Michael Power MD
Clinical Knowledge Author, Guideline Developer and Informatician
Prodigy Knowledge http://www.prodigy.nhs.uk/