JiscMail Logo
Email discussion lists for the UK Education and Research communities

Help for EVIDENCE-BASED-HEALTH Archives


EVIDENCE-BASED-HEALTH Archives

EVIDENCE-BASED-HEALTH Archives


EVIDENCE-BASED-HEALTH@JISCMAIL.AC.UK


View:

Message:

[

First

|

Previous

|

Next

|

Last

]

By Topic:

[

First

|

Previous

|

Next

|

Last

]

By Author:

[

First

|

Previous

|

Next

|

Last

]

Font:

Proportional Font

LISTSERV Archives

LISTSERV Archives

EVIDENCE-BASED-HEALTH Home

EVIDENCE-BASED-HEALTH Home

EVIDENCE-BASED-HEALTH  November 2006

EVIDENCE-BASED-HEALTH November 2006

Options

Subscribe or Unsubscribe

Subscribe or Unsubscribe

Log In

Log In

Get Password

Get Password

Subject:

Re: post-modernists take another whack at EBH

From:

Owen Dempsey <[log in to unmask]>

Reply-To:

Owen Dempsey <[log in to unmask]>

Date:

Wed, 29 Nov 2006 22:20:31 -0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (282 lines)

Dr Poses,



Interesting mailing, if abrasive, closed, and narrow. EBM in reality is not 
taking into account 'experience' or context etc, at least not in UK primary 
care.  We do need to take a more objective view of EBM, as it is being 
practiced, and abused.



You would think that given the harm medicine has done over many generations 
(qv HRT,  (and other examples you can quote better than me) that its 
practitioners would be prepared to listen and engage constructively with 
criticism. I don't care whether you, as an individual, do or not (listen 
that is), I object to the presumptious: 'my worldview is the ONLY way' 
stance you seem to take.  Perhaps tolerance and an attempt at dialogue mght 
be  a better way, maybe these authors have something to teach us, given some 
encouragement.



Look at the words you use: and their implications



'taking another whack'

these people clearly see EBM baiting as an immature game for their own 
selfish pleasures



'Accusations'

Who is accusing you

What  are they accusing you of?

Have you done somebody some wrong

Does some retribution need to  be sought

If so, what do you have in mind

Why have they done what they've done

(Have you asked yourself that?)



'Here we go again'

we've already completely demolished these arguments before, and i'm getting 
tired of this game

(there is no room for dialogue - an aggressive stance)



'thanks to a tip'

this was being kept secret from us ( our little cabal) but we have spys



'the now familiar attributes'

how boring to re visit this nonsense, from idiots, less intelligent than us



'diatribe'

can't be bothered to look this up to be honest



'the apparently deliberate obscurity of these arguments'

they must be a devious lot



my comments:



in reality ebm is being taken over, in the uk by 'the money', govt, and 
public health to re-define good practice, clinical experience is actually 
counting for nothing - 90% of 20 salaried GPs in a session today thought 
that guidelines and financial incentive to use 'depression scores' actually 
diminished quality of care (not published) - the other 10% seemed to like 
the money (or are intimidated by their bosses).



to simplify, my colleagues in general practice are labouring under an 
assault of 'practice' must-dos, from government, in the name of EBM, that 
are not evidence based at all.  Personal experience, empathy, caritas, are 
being sidelined in favour of public health approaches, drug company profits, 
government votability, GP profits and shiny cars.



Beware:  I love good evidence, I understand its limitations, it is being 
abused.



I would call on people to a) try to engage with people who have clearly 
thought through the damage the abuse of EBM is wielding on us all, patients, 
and practitioners.b) resist this abuse of EBM, c) to argue for more relevant 
research questions, and c) to not simply bellow in rage.



Have you copied your 'rage' to them, asked for explanation of their 
'language' steeped as it is in many years of well examined philosophical 
discourse on the nature of knowledge and power, by many well intentioned 
people? If not , why not?



Owen



Owen Dempsey

GP with special interest in education

Hon Sen Lecturer medical education, Leeds
Clinical Lead salaried GP scheme
Bradford City tPCT
Douglas Mill
Bowling Old Lane
Bradford
BD5 7JR
mobile 07760 164420



----- Original Message ----- 
From: "Poses, Roy" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, November 29, 2006 8:38 PM
Subject: post-modernists take another whack at EBH


A while back, I posted on Health Care Renewal 
[http://hcrenewal.blogspot.com/] about post-modernist accusations that 
proponents of EBM were "microfascists" 
[http://hcrenewal.blogspot.com/2006/08/post-modernist-view-evidence-based.html/]

Here we go again.  Thanks to a tip from the Capsules blog 
[http://blog.meetingsnet.com/capsules/], I found this summary of a special 
issue of Social Science Medicine on EBM 
[http://annietv600.wordpress.com/2006/11/28/gift-horse-or-trojan-horse-the-ebm-debate-continues/]. 
In it was this article:
[http://dx.doi.org/10.1016/j.socscimed.2005.11.031]

Goldenberg MJ. On evidence and evidence-based medicine: Lessons from the 
philosophy of science <http://dx.doi.org/10.1016/j.socscimed.2005.11.031> . 
Social Science & Medicine 2006; 62(11):2621-2632.

This article has the now familiar attributes of post-modernist anti-EBM 
diatribes:

Misconceptions of EBM

For example, the author never once acknowledged that EBM takes into account 
clinical experience and the clinical context on one hand, and patients' 
values on the other hand, in addition to the "evidence."  That later allows 
the author to accuse EBM of being an instrument of "the institutional power 
of medicine" that is bad for women patients.

The author also equated EBM with logical positivism, "However, the apparent 
obviousness of EBM can and should be challenged on the grounds of how 
'evidence' has been problematised in the philosophy of science. In this 
paper, I argue that evidence-based practices maintain an antiquated 
understanding of evidence as "facts" about the world in the assumption that 
scientific beliefs stand or fall in light of the evidence. This 
understanding of evidence is explicitly positivist...."  The author then 
argued against logical positivism, and transferred all criticisms of it to 
EBM.

Logical Fallacies

The author made particular use of false dichotomies.  She argued that 
logical positivism, and hence EBM, are based on the notion that people's 
perceptions of external reality "are supposed to provide a a maximally 
certain and conceptually unrevisable foundation of empirical knowledge," 
i.e., that perceptions of external reality are perfect.  She then argues, 
quite unremarkably, that perceptions of reality are imperfect, but then says 
imperfect observations are essentially worthless.  So the conclusion was 
that logical positivist science, which again was equated with EBM, is based 
on worthless observations, implying both such science and EBM are worthless.

The author made the usual post-modernist appeals to (post-modernist) 
authorities.  Since this was a feminist critique, the authorities in this 
case were mostly feminists, although of course there was a bow to the 
ubiquitous Foucault.  In a particularly impenetrable section on "feminist 
epistemologies of science," for example, she asserted

- "Notions of evidence and theories of epistemic agency are, therefore, 
closely related. Haraway (1996) 
<http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4HWXP4C-1&_coverDate=06%2F30%2F2006&_alid=498309077&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=5925&_sort=d&view=c&_acct=C000039639&_version=1&_urlVersion=0&_userid=709070&md5=861b0a5ef32#bib29> 
argues that the notion of  'matters of fact' depends on many kinds of 
transparencies in the grand narratives of the experimental way of life. The 
'modest witness', the protagonist of the dramas of the Scientific Revolution 
who testifies without prejudice to new facts, had to be constructed in 
sufficiently detached and abstracted terms to make plausible the unusual 
situation where his experiences could somehow represent everyone's and 
no-one-in-particular's experiences."

- "Lorraine Code has argued that 'objectivity' is 'a generalization from the 
subjectivity of quite a small group' (1993, p. 22). However, this group 'has 
the power, security, and prestige to...generalise its experiences and 
normative ideals across the social order thus producing a group of like 
minded practitioners ('we') and dismissing 'others' as deviant and aberrant 
('they')' (Code 1993, p. 22 
<http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4HWXP4C-1&_coverDate=06%2F30%2F2006&_alid=498309077&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=5925&_sort=d&view=c&_acct=C000039639&_version=1&_urlVersion=0&_userid=709070&md5=861b0a5ef32#bib8> 
 ).

Setting aside, for a moment, the apparently deliberate obscurity of these 
arguments, why should one believe them just because they were made by 
Haraway or Code?

(Perhaps Deliberately) Turgid Writing

One wonders whether the editor of this article actually understood it all. 
The writing is full of the clumsy constructions and opaque jargon usually 
favored by post-modernists.  I will save you further quotes.  One wonders, 
however, whether the purpose was to deliberately confuse the reader, in the 
hopes that readers so confused would attribute their mental state to the 
vast erudition of the author.

Finally, the Dire Warning

The author finally concluded that EBM is dangerous, at least to women, " 
Feminist critiques of science are driven by a deep concern that the 
abstractions made in the names of scientific objectivity, generalisability, 
and predictability harm women. These tendencies appear to resurface in the 
practice of EBM."

Furthermore, "Feminist insight reveals that the practices of EBM are marked 
by potential or actual gender bias, which has led at least one critic to 
argue that EBM is bad for women's health."

In Conclusion

[Borrowing some wording from my post on accusations of "microfascism," but 
with specific quotes from the Goldenberg article referenced above... ]

Recovering from the brain fever induced by reading about "knowers" as 
"collaborative agents," "experiential 'givenness,'" and "objectified 
body-machines," one might speculate: 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?

If so, it's working.





Roy M. Poses MD
Clinical Associate Professor of Medicine
Brown University School of Medicine
email: [log in to unmask]


-- 
No virus found in this incoming message.
Checked by AVG Free Edition.
Version: 7.5.430 / Virus Database: 268.14.19/556 - Release Date: 28/11/2006 
15:22

Top of Message | Previous Page | Permalink

JiscMail Tools


RSS Feeds and Sharing


Advanced Options


Archives

April 2024
March 2024
February 2024
January 2024
December 2023
November 2023
October 2023
September 2023
August 2023
July 2023
June 2023
May 2023
April 2023
March 2023
February 2023
January 2023
December 2022
November 2022
October 2022
September 2022
August 2022
July 2022
June 2022
May 2022
April 2022
March 2022
February 2022
January 2022
December 2021
November 2021
October 2021
September 2021
August 2021
July 2021
June 2021
May 2021
April 2021
March 2021
February 2021
January 2021
December 2020
November 2020
October 2020
September 2020
August 2020
July 2020
June 2020
May 2020
April 2020
March 2020
February 2020
January 2020
December 2019
November 2019
October 2019
September 2019
August 2019
July 2019
June 2019
May 2019
April 2019
March 2019
February 2019
January 2019
December 2018
November 2018
October 2018
September 2018
August 2018
July 2018
June 2018
May 2018
April 2018
March 2018
February 2018
January 2018
December 2017
November 2017
October 2017
September 2017
August 2017
July 2017
June 2017
May 2017
April 2017
March 2017
February 2017
January 2017
December 2016
November 2016
October 2016
September 2016
August 2016
July 2016
June 2016
May 2016
April 2016
March 2016
February 2016
January 2016
December 2015
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
April 2015
March 2015
February 2015
January 2015
December 2014
November 2014
October 2014
September 2014
August 2014
July 2014
June 2014
May 2014
April 2014
March 2014
February 2014
January 2014
December 2013
November 2013
October 2013
September 2013
August 2013
July 2013
June 2013
May 2013
April 2013
March 2013
February 2013
January 2013
December 2012
November 2012
October 2012
September 2012
August 2012
July 2012
June 2012
May 2012
April 2012
March 2012
February 2012
January 2012
December 2011
November 2011
October 2011
September 2011
August 2011
July 2011
June 2011
May 2011
April 2011
March 2011
February 2011
January 2011
December 2010
November 2010
October 2010
September 2010
August 2010
July 2010
June 2010
May 2010
April 2010
March 2010
February 2010
January 2010
December 2009
November 2009
October 2009
September 2009
August 2009
July 2009
June 2009
May 2009
April 2009
March 2009
February 2009
January 2009
December 2008
November 2008
October 2008
September 2008
August 2008
July 2008
June 2008
May 2008
April 2008
March 2008
February 2008
January 2008
December 2007
November 2007
October 2007
September 2007
August 2007
July 2007
June 2007
May 2007
April 2007
March 2007
February 2007
January 2007
December 2006
November 2006
October 2006
September 2006
August 2006
July 2006
June 2006
May 2006
April 2006
March 2006
February 2006
January 2006
December 2005
November 2005
October 2005
September 2005
August 2005
July 2005
June 2005
May 2005
April 2005
March 2005
February 2005
January 2005
December 2004
November 2004
October 2004
September 2004
August 2004
July 2004
June 2004
May 2004
April 2004
March 2004
February 2004
January 2004
December 2003
November 2003
October 2003
September 2003
August 2003
July 2003
June 2003
May 2003
April 2003
March 2003
February 2003
January 2003
December 2002
November 2002
October 2002
September 2002
August 2002
July 2002
June 2002
May 2002
April 2002
March 2002
February 2002
January 2002
December 2001
November 2001
October 2001
September 2001
August 2001
July 2001
June 2001
May 2001
April 2001
March 2001
February 2001
January 2001
December 2000
November 2000
October 2000
September 2000
August 2000
July 2000
June 2000
May 2000
April 2000
March 2000
February 2000
January 2000
December 1999
November 1999
October 1999
September 1999
August 1999
July 1999
June 1999
May 1999
April 1999
March 1999
February 1999
January 1999
December 1998
November 1998
October 1998
September 1998


JiscMail is a Jisc service.

View our service policies at https://www.jiscmail.ac.uk/policyandsecurity/ and Jisc's privacy policy at https://www.jisc.ac.uk/website/privacy-notice

For help and support help@jisc.ac.uk

Secured by F-Secure Anti-Virus CataList Email List Search Powered by the LISTSERV Email List Manager