Mo’ evidence-based microfascism?

Straw Man. Photo by Natmandu.

From Bad Science comes news that bloggers are eviscerated in a post-modern way by Professor Alan Pearson. Remember the paper Deconstructing the evidence-based discourse in health sciences: truth, power and fascism? Prof Pearson takes to task commenters on one specific blog who denigrated this paper in a non-scholarly way in his paper Scientists, postmodernists or fascists?, behind subscripition barrier. The abstract is fascinating:

The somewhat frenzied reaction to publication of a provocative, discursive paper titled ‘Deconstructing the evidence-based discourse in health sciences: truth, power and fascism’ by Holmes et al. in the International Journal of Evidence-Based Healthcare is both surprising and worrying.

Worrying perhaps, but surprising? Someone says that scientists are a bunch of microfascists in a provocative manner, and you’re not expecting a reaction? What kind of reaction should someone expect from a provocative paper? It is possible that Pearson is expressing surprise that anyone could be bothered to read it.

The paper is essentially a postmodernist critique of evidence-based healthcare. In the same issue of the journal in which the paper was published both the guest editorial and a response to the paper refute its claims.

This I will admit confuses me slightly. The paper was about Evidence-Based Medicine, which I took to be a specific system which had taken the name and not necessarily about all medical research that was evidence-based. This would be interesting because then by taking that name you’re implying that research which doesn’t work to those criteria isn’t evidence-based. Which is why I didn’t feel the urge to take it apart, because not all of the paper was evidently rubbish to me as a non-specialist, merely substantial portions. Nor was I aware of the response or editorial and I’ll come back to that.

However, media coverage on the paper gave rise to numerous defensive responses that attacked the paper through claiming it represents ‘bad science’ or by disparaging the International Journal of Evidence-Based Healthcare, its Editor, its peer review processes or the organisation linked to the journal, the Joanna Briggs Institute. It is clear that those who mounted these attacks had no knowledge of the journal (or of the editorial and response refuting the claims made in the paper, published in the same issue) or its parent organisation; and none of them attempted to critique the paper in a scholarly fashion.

So, if I understand the argument correctly, Pearson’s arguments are:

1. The attacks aren’t evidence-based

2. That might be amusing, but for reasons above I’m not convinced evidence-based means the same as Evidence-Based. There is an obvious reason for why the criticisms are not fully evidence-based. This is tackled below if you can’t work out why.

3. The responses did not cohere to the form of the scholarly journal in which they were published.

4. Now this is interesting. The major point of the paper is that the respondents on the web didn’t respond in the established way. Fair play to the Professor, he does point out below in his abstract that this too could be construed as microfascist – however acknowledging the point doesn’t refute it.

5. The sum total of responses to the paper are represented by the comments on the Bad Science blog.

6. This is indefensible.

For a start, there is no substantial response in the full paper to the commentary by Ben Goldacre, the chap that wrote the article that the commenter are responding to. Further there is more than one website available on the internet. There are other comments. Here’s an entry on Pharyngula, which isn’t a blanket condemnation. Here’s another entry at Respectful Insolence. Orac puts together a long article discussing the paper and bringing evidence from other sources. This isn’t ill-informed rambling, it is a serious critique, even if it isn’t in a traditional format. It’s also skewered briefly by Ophelia Benson at Butterflies and Wheels. While the entry is brief, there is extensive discussion in the comments which, ironically, question the rigour of the original paper. That’s quite a collective critique. How do you respond to that?

Pearson doesn’t.

This paper sets out to construct a scholarly argument to refute these claims and to consider why it is that those who support evidence-based healthcare and/or science chose to disparage a journal and an organisation that promotes and facilitates evidence-based approaches to healthcare – and the value of the Cochrane Collaboration – rather than developing a rigorous critique of the argument developed in the Holmes et al. paper.

Interesting use of the word rigorous, which is a value-laden term. It implies that rigour is mono-dimensional, that there is one uncontested scale of rigour and that the Professor is in a position in which he can judge this. As for scholarly, I suppose this depends on what Pearson’s target is. If it’s blog-centred critique of the Holmes paper, then it’s poor.

Although this response appears to be an attempt to silence dissenting views (and may, to some, suggest that the reference to microfascism in the paper in question may, indeed, have some validity) we conclude that the postmodernist critique of evidence-based healthcare embodied in the paper sets out criticisms that, though widespread in healthcare, can be challenged in a considered, scholarly way. The ill-informed, reactionary responses to it by the defenders of science make little contribution to the ongoing development of evidence to improve global health.

So here the ends, post-modern emancipatory liberation, justify the means, which appears to be a titled authority selecting a weak target for criticism. Here ends the abstract.

Now if I left the end there, then this would be a largely mis-representative critique of Pearson’s article. This would be a shame as a lot of it is rather good. Thankfully the full response is at Bad Science. It’s worth reading. From the comments above you may think that Pearson defending the Holmes paper. In fact he also critiques that too.

The authors’ interpretation of the ‘texts’ deconstructed – that is, the references cited – in relation to this assertion reflect their allegiance to a view that sees science as a movement that devalues all other forms of knowing and doing and their suspicion that, whenever the products of science are applied in practice, practitioners rely solely on it and separate themselves from other knowledge sources and there own subjective being. Proponents of the evidence-based approach make no such claims, nor can they be found in the ‘texts’ deconstructed by the authors.

and

They go on to assert that, ‘When only one method of knowledge production is promoted and validated, the implication is that health sciences are gradually reduced to EBHS. Indeed, the legitimacy of health sciences knowledge that is not based on specific research designs comes to be questioned, if not dismissed altogether. In the starkest terms, we are currently witnessing the health sciences engaged in a strange process of eliminating some ways of knowing.’ None of the ‘texts’ addressed by the authors adopt such a view; furthermore, to suggest that health professionals unquestionably subjugate their own knowledge and judgement assumes a level of naivity and lack of intelligence that disregards the sophistication of doctors, nurses and allied health professionals.

That to me suggests that Prof. Pearson is just as scathing about the Holmes paper. The response from commenters at Bad Science to the entry Take that, you pesky microfascists…? The very first was

hahaha – Stever

…and after the full paper appears?

I have never had to wade through so much vapid, contentless drivel since… well, since you posted the original article the first time round, actually. – Ithika

…and this to me is why it’s worrying. Pearson is right, the commenters on Bad Science were ill-informed, but one major reason they were ill-informed is that the original journal is not-widely circulated and behind a subscription varrier. If all I read of Pearson’s paper was the abstract, then I would be ill-informed to and, as I have shown above, held an erroneous opinion of the paper. Partial information on a paper is not merely less useful than the full paper, in this instance it’s a hazard. I think that this is a clear example of why open-access publishing is so desireable. Or at least it should be.

Another factor that I think Pearson reasonably shows is that there is a degree tribalism and that no provision of evidence is going to make some people change their minds. In the case of the critiques of the International Journal of Evidence-Based Healthcare, the demonstration of a counterpoint which tackled the original paper made no difference to many opinions on the journal. In the case of his own paper, the mere fact that critics are themselves criticised is enough to place him in the post-modernist camp.

Another criticism of the paper is a bit silly. Responding to blog comments is currently a bit odd in a peer-reviewed journal, but isn’t this a good thing? Someone taking taking the time to read criticisms, examine them and publish a response is surely what many bloggers would want? There are problems in Pearson’s article as a critique though. It is narrow. Indefensibly narrow? Here’s a search on Google, another on Technorati, IceRocket and Sphere. There’s plenty of other entries to be found.

Having read the full paper I don’t think Pearson is willfully ignorant of the other comments, but it does show why linking is important in blogs and that developing responses to blogging are going to be difficult with errors made along the way. Blogging is not scholarly publication, and many bloggers will never be publishing scholarly work for good reasons, as Warumich explains.

In some ways I wish I’d used a pen-name. As it is I don’t blog about students. I’m identifiable, so they are also likely to be identifiable. This means I can’t blog about problem students and ask for advice. Thankfully I’m blessed that I have no problem students, but it would be nice to have the option. This anonymity means that verification of commenters will always be problematic and there will always be people willing to give their tuppence worth on a blog, regardless of the size of their overdraft.

As a response to blogged critiques of the Holmes et al paper, I think that Pearson’s response fails. He doesn’t acknowledge the variety of responses, nor appears understand some of the aspects of blogging, like why pseudonymity occurs.* However, I don’t think it irredeemably fails and the effort itself should be applauded. Had the exchange occurred in an open-access journal I doubt the commentary of the journal would have been so negative, and Pearson’s own article would be better received. His willingness to write an article engaging with bloggers is admirable.

As a response to the original paper it’s seems reasonable. My major quibble is that he says post-modernism “is alive and well in some quarters“. I’m struggling to think of any field that post-modernism is alive and well in. I accept the authors of the original paper might claim to be post-modernists, but citing Deleuze or Guattari as authority figures and defining reality purely in relation to their position as authorities doesn’t sound very post-modern to me. One commonly mentioned feature of post-modernism is challenge to authorities, but that is perhaps more a philosophical rather than nursing point. Maye it will be addressed when Holmes et al publish more of their work in philosophical journals or at the Philosophy conferences they attend.

Technorati Tags:open access publishing, open access, postmodernism, medicine

Updated Dec 13: And sometimes I get it wrong. I missed this entry by Ben Goldacre with responses from the authors was in the comments. It’s getting all the scorn it deserves. Once again Orac takes it apart better.

*If it is purely a response to commenters on Bad Science it fails because it puts the reply away from where they can reasonably be expected to find it, as Pearson himself recognises.