August 18, 2006

Science: The Occasional Embarrassment

All right: if I can brag about Canadians on the motorcycle racing circuit, then I suppose I've got to take the hit when Canucks do some spectacularly stupid things, too.

To wit, this article written by four members of the Ryerson staff and appearing in the, uh, International Journal of Evidence-Based Healthcare:

"Deconsturcting the evidence-based discourse in health sciences: truth, power and fascism"

You read that right! The FASCISTS have taken over science! Save yourselves!

What follows is a whole lot of complaining about how the scientific world is just, like, so totally unfair! It's a teenage screed dressed up in intellectual jargon. I'm going to reprint a bit of it here (the abstract, a bit of the introduction, and a bit of the conclusion), but if you want to read the whole thing, follow the quoted bit above. Just have some ear plugs handy to block out the perpetual whine.

This being said, I realize what the authors are trying to say, that the publication of works in influential trade magazines and journals is controlled, perhaps (as their argument goes) by fascists; and so alternative theories and contreversial studies end up published in the International Journal of Evidence-Based Heathcare or the Fortean Times. This leads to those unpopular theories being shunted aside or ignored, when they should be discussed in the open by all academics.

"Dad won't give us the keys to the car," they're saying, "so we're pouting." We hate living here! You're fascists, and we wish you were DEAD! Now we're going to our room and listening to Maralyn Manson as LOUD AS WE WANT!

*SLAM*

The Journal is a publication of the folks at the Joanna Briggs Institute, who are mostly focused on nursing and midwifery. These are both noble and necessary pursuits, and if I said a word against either of them, I'd catch my mom's shoe on the side of my head.

But.

Nursing does tend to be a field that allows for a "softer" view of medicine; it's where we find strong support for silliness like therapeutic touch or homeopathy. These, needless to say, simply don't stand up very well to any sort of rigorous testing and review, so calls from supporters to change the rules of testing are frequent.

Without further ado, the abstract:

Background
Drawing on the work of the late French philosophers Deleuze and Guattari, the objective of this paper is to demonstrate that the evidence-based movement in the health sciences is outrageously exclusionary and dangerously normative with regards to scientific knowledge. As such, we assert that the evidence-based movement in health sciences constitutes a good example of microfascism at play in the contemporary scientific arena.

Can you tell one of the authors had a PhD in English? The primary complaint is stated boldly here, as is the background's purpose. Unfortunately, the hypothesis itself is wrong: there are badly researched papers being handed to magazines and journals all the time, and when they aren't published it's because of their incompetence or even just their poor writing rather than an international cabal of lab-coated Machiavellis keeping The Truth hidden away. Ask any publisher if they would publish a well though-out, well researched theory that would change the world of science, and see how many say "World changing science? Gosh, I dunno. Let me think about it..."

As for being "dangerously normative", it's the application of standards. In much the same way food inspectors are hated by bad resturants, so academic journals are hated by bad scientists.

Oh, and I love "microfascism"! I suppose nanofascism (the unspeakable way people control the cars they drive) and picofascism (the body's utter dominance over when its heart beats) are coming next.

Objective
The philosophical work of Deleuze and Guattari proves to be useful in showing how health sciences are colonised (territorialised) by an all-encompassing scientific research paradigm – that of post-positivism – but also and foremost in showing the process by which a dominant ideology comes to exclude alternative forms of knowledge, therefore acting as a fascist structure.

Especiall when those "alternative forms of knowledge" seem to be summed up in the phrase "I dunno. It just feels right." Gee, such a shame to exclude that from publication in serious journals of hard medicine.

Small primer on how science works: Seeing what is around us, making observations, confirming those observations, then (and only then) creating a testable hypothesis around those observations. And if the tested hypothesis fails, then it is discarded in the face of reality, whatever the desires of the tester may be.

If the ability to reason is considered fascistic, then I suppose we're all fascists. Bummer.

Conclusion
The Cochrane Group, among others, has created a hierarchy that has been endorsed by many academic institutions, and that serves to (re)produce the exclusion of certain forms of research. Because ‘regimes of truth’ such as the evidence-based movement currently enjoy a privileged status, scholars have not only a scientific duty, but also an ethical obligation to deconstruct these regimes of power.

The Cochrane Group, for those who don't know, created a database of scientific research so clinicians would have access to information quickly and easily. The crime, as seen by these authors, was to insist that any research that was included in the database had to be done with randomized controlled trials. This stops what they see as "progress" in health care by not allowing "many forms of knowing/knowledge". This creates the heirarchy they rail against, biasing it all in one direction: clinically testable procedures.

For shame!

Now, if by "deconstruct", the authors mean examining the traditional acceptance of truth, I'm cool with that. The repeated examination of assumptions is not only good for science, it's good for humans, it's good for societies of every size, and it's good for businesses. What they perhaps fail to realize is that science constantly and continuously challenges itself. This is why things like the age of the earth has been revised so frequently; why Newtonian physics has been partially replaced by relativity, which has been partially replaced by quantum physics.

If, on the other hand, they mean "deconstruct" as in to destroy, well... Does that mean I can call you "scientific anarchists"? Please? It's a simple thing to eliminate or marginalize a field of science or method of research: come up with something better. It's that easy.

A touch of the introduction:

Introduction

We can already hear the objections. The term fascism represents an emotionally charged concept in both the political and religious arenas; it is the ugliest expression of life in the 20th century. Although it is associated with specific political systems, this fascism of the masses, as was practised by Hitler and Mussolini, has today been replaced by a system of microfascisms – polymorphous intolerances that are revealed in more subtle ways.

Um, so it surprises you that people may get upset when you directly compare publishers to Hitler and Mussolini?

Consequently, although the majority of the current manifestations of fascism are less brutal, they are nevertheless more pernicious.

Gee, thanks.

Therefore, we will use this term as defined by Deleuze and Guattari, and now used by a number of contemporary authors. Within the healthcare disciplines, a powerful evidencebased discourse has produced a plethora of correlates, such as specialised journals and best practice guidelines. Obediently following this trend, many health sciences scholars have leapt onto the bandwagon, mimicking their medical colleagues by saturating health sciences discourses with concepts informed by this evidence-based movement.

Ah, the "evidence-based movement". That would be the folks who are most enthusiastic about needing proof for theories before trying them out on the patients who rely on them. As for the "best practice guidelines" you're complaining about, bear in mind that they are guidelines, especially where something like oh, say, midwifery is concerned. The individual taking responsibility for their patients still has to deal with the people in front of them, and every case is unique, but having a guideline is not a bad thing. It gathers together evidence of what has worked for others plus what is proven in clinical trials to aid the practicioner. Plus, those guidelines occasionally change, like the "chest thump" being removed from the practice of cardoipulmonary resuscitation (or CPR - learn it) when it was found to be less effective than compressions.

And finally, from the conclusion:

Conclusion

We must resist the totalitarian program – a program that collapses words and things, a program that thwarts all invention, a program that robs us of justice, of our meaningful place in the world, and of the future that is ours to forge together. Paradoxically, perhaps, an honest plurality of voices will open up a space of freedom for the radical singularity of individual and disparate knowledge(s). The endeavour is always a risk, but such a risk is part of the human condition, and it is that without which there could be no human action and no science worthy of the name.

There's that english doctorate again. And yes, there are paragraphs based on George Orwell's 1984 (no, I'm not kidding). This is an interesting argument, that by not co-operating and pooling our knowledge but instead having everyone go their own way we'll somehow make better progress in health and science.

Let's ignore the fact that that's exactly what science has done, and continues to do, eh? Thing is, we've accepted what works best, and that includes methods of research, in compiling things like textbooks and reference manuals and data bases. What works is what gets passed on as knowledge: what doesn't has been discarded. Refining what works, building upon fact and improving designs is part of the very foundation of science, as is convincing others that your own contrarian view is the right one: if your idea is strong enough, and has the facts to back it up, and works better than the previous idea, you will win.

Hence our knowledge progresses: not through wishful thinking, not by hiding research where no one can see it, and certainly not by demanding the rules change without showing why they should.

For which I, for one, am thankful.

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posted by Thursday at 1:54 pm

2 Comments:

Blogger Gazetteer said...

And what is the evidence that the conclusions drawn by these authors is based on, oh, I dunno.....

Evidence?

.

6:37 pm  
Blogger Thursday said...

And that's the crux of it, eh Gaz?

The "paper" is just a poorly disguised opinion piece, nothing else.

9:15 pm  

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