Is this paper a hoax or not a hoax? You be the judge!

May 29, 2017 • 2:00 pm

Okay, here’s a 2006 paper from the International Journal of Evidence Based Healthcare that calls for a questioning of the need for evidence. The journal is from Wiley, a reputable publisher, but have a look at the paper (click on screenshot to go to it):

A few excerpts:

From 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.

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.

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.

and

It is becoming increasingly evident that an unvarying, uniform language – an ossifying discourse – is being mandated in a number of faculties of health sciences where the dominant paradigm of EBHS has achieved hegemony.14 This makes it difficult for scholars to express new and different ideas in an intellectual circle where normalisation and standardisation are privileged in the development of knowledge. The critical individual must then resort to resistance strategies in front of such hegemonic discourses within which there is little freedom for expressing unconventional thoughts.

Rather than risk being alienated from their colleagues, many scientists find themselves interpellated by hegemonic discourses and come to disregard all others. Unfortunately, privileging a single discourse (evidence-based medicine (EBM)) situated within a single scientific paradigm (postpositivism) confines the researcher to a yoke of exactly reproducing the established order. To a large degree, the dominant discourse represents the ladder of success in academic and research milieus where it establishes itself as a weapon used against those who praise the freedom of scientific inquiry and the free debate of ideas. When only one discursive formation (EBM) finds itself on the discursive terrain (health sciences), academics and researchers constitute a united community whose ways of speaking and thinking thwart both creativity and plurality in the name of efficiency and effectiveness.

We believe that EBM, which saturates health sciences discourses, constitutes an ossified language that maps the landscape of the professional disciplines as a whole. Accordingly, we believe that a postmodernist critique of this prevailing mode of thinking is indispensable.

and

The mastery of scientific Newspeak is, for the most part, a regurgitation of prefabricated formulas (buzz words or catch words) that is informed by a single, powerful lexicon. This new guide book of scientific vocabulary, including terms connected with EBM (e.g. systematic literature review, knowledge transfer, best practices, champions, etc.), is taken seriously in the realm of health sciences, so much so that it is considered vital as a reflection of ‘real science’. The classification of scientific evidence as proposed by the Cochrane Group thus constitutes not only a powerful mechanism of exclusion for some types of knowledge, it also acts as an organising structure for knowledge and a mechanism of ideological reinforcement for the dominant scientific paradigm. In that sense, it obeys a fascist logic

Hoax or not? See beneath the fold.

Answer: Not a hoax. It’s been 11 years since this was published and there’s no indication on the Internet that this was a bogus paper. The first author is a real person, and Ben Goldacre took this obscene paper apart when it was published. And the paper, in the International Journal of Evidence Based Healthcare, calls the use of scientific evidence “fascistic.” Such is the result when postmodernism, which holds that nobody has a better handle in the truth than anyone else, gets hold of a field.

95 thoughts on “Is this paper a hoax or not a hoax? You be the judge!

  1. If any doctors ever treat the authors for anything, I hope they’ll be either doctors who’ve read the paper & believed it, or doctors who’ve read the paper and have resolved to act AS IF they believed it (when, and only when, the patients are the authors).

    1. Microfascism, or perhaps just fascism/cishet patriarchal female beauty standards, according to many radical regressives, is taking your weight when you come on for a checkup, telling you obesity is unhealthy, and/or suggesting that maybe you should do something about the fact that you’re 75 pounds overweight, and that it’s really bad for you and your long-term health.

      1. If you’re 75 lbs. overweight you a)know it, and b)have probably struggled to deal with it. Weight control, especially for post-menopausal women, can be extremely difficult.

        I wouldn’t call it fascism, but there are members of the medical community who can’t see past weight and are unwilling to take time to assess an overweight patient’s symptoms to consider the possibility of other issues. Most of us obese women have dealt with them. They are not helpful; they are harmful.

        It is not surprising that a few victims of these “doctors” take an over-reactive stance.

        1. No, I’m talking about blogs where people say that taking your weight, advising you that being overweight in unhealthy, and/or giving you suggestions on how to reduce your weight (assuming — how dare they — that you’d want to) is abusive and shouoldn’t be done. Ever.

          Doctors usually don’t know what other doctors have told their patient. Their job is to assess any health problems and give advice on what their short and long-term health risks are and how to minimize them. To say doctors shouldn’t do this because talking about your weight is “triggering” to some people is a bit absurd.

        2. Sorry, but a doctor can never assume you know anything. The doctor should be kind, compassionate, thoughtful, and non-judgmental, but she can never leave something unaddressed on the assumption that the patient already knows and has probably already addressed this particular issue. That is a formula for disaster. It’s unethical and it’s bad medicine.

  2. Frankly, the journal name sounded like a hoax. I had to go look to make sure it wasn’t really a journal attacking evidence-based healthcare. What would a journal with such a focus publish such as useless, harmful article?

  3. Along these lines: here, taken from the American Journal of Public Health, is a passage listed under the category of “Causal Explanation” proper to the natural sciences:

    “It is widely appreciated that inference of a causal relation requires documentation of the temporal sequence of the phenomena being investigated. This principle applies to the study of life and death no less than in other areas. Recently, there has been considerable excitement in this field, because a breakthrough has been achieved in the mathematical modeling of migration. When the effects of migration are eliminated, a close correspondence between birth and death rates emerges, but with a variable induction period, ranging from less than a day to over 100 years.”

    I withheld a reference from the passage—to “Lemming, Lemming, Lemming and Mietinnen, personal communication”—which gives away the fact that this is a parody of medical writing.

  4. Maybe one or more of the authors had his/her pet theory demolished by a Cochrane review of the evidence.
    Hell has no fury…. etc

  5. I would never have imagined that such filth could ever been published in a reputable journal. Why wasn’t it retracted?

    1. One retracts papers for a number of reasons, such as methodological flaws or fraud. This paper involves no method that that can be flawed and the authors believe what they said, so no fraud. This style of sociological/philosophical paper is opinion with supporting arguments cherry-picked so as to prevent falsify-ability. About the only reason a paper like this could ever be retracted is plagiarism.

  6. I think medicine will remain evidenced based because doctors (MD) are generally too sensible to believe this nonsense and also don’t want to be sued for malpractice. I certainly hope this is the case.

      1. I agree. Big Fat Surprise is one of my favorite books because it shows that government agencies can mistake flimsy evidence from biased sources for solid evidence. Any attempt at evidence based practice is better then rejecting the whole idea of evidence based practice. Science is not broken, just very hard to do right.

      2. This. I’m afraid “evidence based” is more a slogan than a reality, and does indeed sometimes lead to the substitution of buzzwords for genuine thought. A stopped clock is right twice a day. When the authors wrote that sentence, it was that time of day.

        1. If this slogan is not yet a reality, professionals must work hard to make it a reality, instead of calling it fascistic.
          In empirical sciences, you cannot go far by “genuine thought” alone. You need – unfortunately – evidence.

      1. As the parody I posted suggests, we can only hope that things change and that they learn how to write. I was a medical technical editor for 20 years and the doctors/researchers would defend themselves by saying “They didn’t teach us how to write in medical school.” My reply was always the same: “That’s nonsense. Of course they taught you how to write. No one writes that way naturally.”

  7. I knew this wasn’t a hoax, unfortunately. I used to work in the health arena. There are medical professionals who, in an attempt to empathize with their patients begin to believe the quack theories those patients find on the Internet. There are also med. proffs. who are anti-vax and anti-fluoride, for example. Rather than believe or admit they’re wrong, they blame “the establishment”.

    1. My hairdresser and and a certified audiologist at well respected medical center both told me to try Chinese herbs for my son’s ear infections. I ignored the hairdresser, but was quite upset that the audiologist would recommend quackery. You can’t always trust medical professionals.

      1. A lot of physios in NZ, most of whom receive government funding for treatment costs, offer acupuncture. I hate the fact that tax dollars are paying for acupuncture.

          1. “You think they should have experimented on their son?”

            In a word, yes. I think we’re sometimes too quick to interpret lack of evidence for a benefit as evidence for harm, as if the main goal were not to get results but to preserve our self-image as good little rationalists who aren’t easily duped. We’re not talking about setting public health policy, we’re talking about an individual trying something that may or may not help but that will almost certainly “do no harm.” This is the case with most “home” or herbal remedies as opposed to, say, chiropractic, which has been shown to have harmful effects, So if there’s even an outside chance of benefit and no evidence of potential harm, then experimenting would seem the most rational option. Even Western medicine, after all, acknowledges the placebo effect.

  8. Not a hoax, ok, but ya coulda fooled me.
    Well, we can simply rebut by explaining that the models for disease and the efficacy of their cures were established by EBM because EBM is the best we got for developing safe and effective treatments. No one in the field would claim that it is a system that is perfect and without error. I can go on at length about its various problems. But I don’t think that the claimants for alternative medicine for example are being prevented from doing double-blind experiments to test if their claims hold up to reality. It is just that people who claim that kind of thing basically suck at doing the hard work.

  9. I can already hear the response of those who told us that the conceptual penis hoax proved nothing: “it proves nothing.”

    1. Would you say that presenting, say, 50 black sheep would prove to you that all sheep on the planet are black?

      Would it prove to you even only that most sheep are black?

      Would you consider somebody who argues that 50 black sheep do not prove that all or even only most sheep on the planet are black to be a pomo-infected, regressive leftist? Or would you consider it possible that even somebody who completely agrees with you that most sheep are black would have to to argue that a mere 50 sheep cannot prove that?

      1. Probably not a truly random sample. Math education does not adequately address statistics and probability.

        1. Okay, then why not apply the same logic to the present case? It shows that there are some scholars who write at least some ridiculous papers. Which is much, much more than the conceptual penis so-called-hoax did, admittedly, but if the question is whether all of ‘cultural studies’ are nonsense then a completely different methodology is needed.

          1. I already begin to think that no methodology, nothing can show the supporters of “cultural studies” that this academic branch is nonsense.

          2. When they start by rejecting the value of evidence and proceed to call logic fascism …

          3. FWIW, I am not a “supporter” of postmodern studies, quite the opposite. I am a supporter of science and rationality, which means that it offends me when I see reasoning on the lines of “here is one bad example, that proves everything is bad”.

          4. It is not one bad example, it is thousands of bad examples. Actually, it is difficult to find a good example. So far, none of the “gender studies” supporters has cited even one. (For the record, I can find one or two.)

          5. Proving beyond doubt that all of gender studies is bollocks will still not demonstrate that the ‘hoax’ made sense, or that the people celebrating understood why it did not make sense, or that the celebrations of it were not an embarrassment.

            This is literally like “you are an irrational SJW regressive leftist for not accepting that my bicycle stunt demonstrates phrenology to be pseudoscience”. It does not even matter if phrenology is pseudoscience, the stunt is still irrelevant, and somebody who says so is simply correct.

      2. If someone painted a sheep black and successfully passed it off as a black sheep, and, even after the painter revealed the deception, the half shepherds still insisted the sheep was black, while the rest cried it wasn’t a reputable farm anyway, I’d call bullshit on the wool industry.

        1. In the present case, the person who the sheep was supposedly passed off is, however, in the business of getting paid to say things are black.

  10. Fortunately, the one author (Murray) listed as being my institution is no longer at Ryerson. Unfortunately, he actually got a Canada Research Chair (see https://stuartjmurray.com/, but be prepared – it ain’t pretty).
    The scary part is that I actually had a couple of email exchanges with him while he was at Ryerson, and he seemed perfectly normal!
    Ya just can’t tell sometimes.

  11. For those who would like to see the whole paper, Ben Goldacre has thoughtfully provided a link, which points to an archive maintained by Professor David Colquhoun: http://www.ucl.ac.uk/Pharmacology/dc-bits/holmes-deconstruction-ebhc-06.pdf
    I looked at Holmes’s U Ottawa website – he seems to be making a career out of this sort of thing: his bio says “Most of his work, comments, essays, analyses and research are based on the poststructuralist works of Deleuze & Guattari and Michel Foucault”, and a scan through his list of papers is more of the same.
    Bizarre.

    1. This one is a doozy, too.

      ‘We hold these truths to be self-evident’: deconstructing ‘evidence-based’ medical practice’

      “…Results EBM’s strict distinction between admissible evidence (based on RCTs) and other supposedly inadmissible evidence is not itself based on evidence, but rather, on intuition. In other words, according to EBM’s own logic, there can be no ‘evidentiary’ basis for its distinction between admissible and inadmissible evidence. Ultimately, to uphold this fundamental distinction, EBM must seek recourse in (bio)political ideology and an epis- temology akin to faith.”

      https://modernrhetoric.files.wordpress.com/2010/11/devisch_and_murray.pdf

  12. “…an all-encompassing scientific research paradigm – that of post-positivism…”

    Now there’s a twist. The post-modern movement originates in the aftermath of the failure of positivism in the early 20th century. Now they blame post-positivism (post-modernism) for usurping the health field. But post-modernism is exactly their own ideological basis. It’s a snake biting it’s tale.

    1. To many pomos “positivism” means nothing like what Carnap and those guys did or Comte, etc. It just means “science lover”, meant perjoratively. So “post-positivist” means “we don’t have to listen to scientists anymore, so nyah!”.

  13. Again, there are several different questions that should not be conflated:

    (1) Did the hoax make sense and show what it was meant to show? Or was celebrating it a failure of skepticism and/or a misunderstanding of how predatory publishing works?

    (2) Is this paper here nonsense? Is that one over there?

    (3) Is all or at least most of culture studies nonsense?

    Answering the second with yes does not make a point regarding the first nor, it could be argued, the third, given how many odd papers there are even in biology.

  14. Alan Sokal published a book in 2008 with the title “Beyond the Hoax”.

    The sentence which begins “The classification of scientific evidence as proposed by the Cochrane Group thus constitutes not only a powerful mechanism of exclusion for some types of knowledge …”

    is quoted from this 2006 Holmes paper. The 2008 book apparently contains articles that Sokal had previously published as well as some new material.

  15. Part of me is reassured by the notion that if I, a simple geologist, can read the abstract and know the paper is so much fertilizer, then people in the field reading it will do so, too. But, but, but… people in the field ***wrote*** it. So obviously some subset of scientists (using that word casually) maybe do believe in this stuff? That’s scary.

    Also, what the publishing says about peer review is pretty dismal.

    1. It seems to me that there are two types of scientists (I know, I know). Those that have a primarily scientific approach to the world, and those who have primarily a social approach to the world (and who happen to be employed as scientists).

      Same with priests, philosophers and many other ‘trades’, and there’s a lot of tension between those orientated on their trades and those who do them as a ‘day job’.

  16. The senior author Genevieve Rail is now Professor of Feminist Cultural Studies of Health at the Simone de Beauvoir Institute of Concordia University. She is also an antivaxxer. Her criticisms of HPV seem to be based on the lived experiences of parents whose daughters experienced medical problems after receiving the HPV vaccine.

    http://news.nationalpost.com/news/canada/concordia-professor-condemns-hpv-vaccine-after-winning-270k-federal-grant-to-study-it

    1. Note that Concordia has no medical school. I’ve seen some nonsense come out of McGill’s, but at least there a “studies of health” might be appropriate. For example, McGill has a “Social Studies of Medicine” unit which has some dubiousness and some sane. The former includes the terminally clueless M. Somerville who is famous for her fatuous attempts to use “tradition” to justify her conservativism.

    2. ‘Professor of Feminist Cultural Studies of Health’

      Says it all, really, doesn’t it?

      [Snark quotient of this comment: 100%]

      cr

  17. I read the newspaper article Michael Hart refers to above. Apparently Rail’s criticism of HPV vaccination is based on the testimony of “some” of the 170 parents she interviewed who thought their daughters’ medical problems “might” be due to the vaccine. I think if I were deciding whether to have a child vaccinated for HPV I’d look at some real clinical trial evidence. I always prefer data to anecdotes!

  18. As I started reading it, the voice of that South African student, who was going on about “decolonizing your minds”, a South African-based Science, and mystics who you could hire to send lightning bolts at your enemies. started narrating it for me. So I thought it was a hoax, or that she had read the paper and took it to heart.

  19. One of the authors of this paper, Genevieve Rail, has emerged as a leader of amovement against the HPV vaccine Gardasil — a perfect practical follow-up for someone who doubts the need for evidence.

  20. “… ways of speaking and thinking thwart both creativity and plurality in the name of efficiency and effectiveness.”
    My favourite part. You can keep your efficient and effective treatments. Give me a plurality of creative injections every time. Sounds way more fun. Even if you do have to sacrifice the effectiveness, what a way to go!

  21. Sadly, the author of this paper id the editor of a journal that’s full of papers like this.

    http://www.oa.uottawa.ca/journals/aporia/

    ” … In the critical analyses of health-related matters, Aporia advocates and embraces a wide range of epistemologies, philosophies and theories including but not limited to: cultural studies, feminism(s), neo-marxism, postmodernism, poststructuralism, postcolonialism and queer studies. … ”

    Geez!

    1. And note not one of those is a mainstream position in epistemology! I’m not adverse to using anything deemed appropriate, but when someone lists epistemologies and doesn’t mention any of the mainstream positions, it raises huge alarm bells even before one sees “postmodernism” and the other posts-, alas. (Shame, as usual, because many of them have sensible goals if inane or worse means.)

  22. Without reading all the comments – this was also published afterwards –
    Scientists, postmodernists or fascists?
    Alan Pearson RN MSc PhD FAAG FRCN
    First published: 16 November 2006
    DOI: 10.1111/j.1479-6988.2006.00054.x
    http://onlinelibrary.wiley.com/doi/10.1111/j.1479-6988.2006.00054.x/abstract

    Abstract

    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. 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. 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. 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. 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.

    1. Translation: “We published some nonsense without believing it ourselves, and see how the stupid, ill-informed defenders of science are attacking us for our clever move!”

    1. Unbelievable. Perfect example of what Sokal was on about – a use of physics or mathematics without a slightest clue as to what it is about. I’m assuming not hoax, because a lot of the craziest stuff in Sokal’s parody was just quotation or citation, after all. (This is, BTW, one fundamental difference between it and the recent one.)

  23. “I can only look with repugnance… upon the puffed-up pretentiousness of all these volumes filled with wisdom, such as are fashionable nowadays… Even the complete annihilation of all these fanciful achievements could not possibly be as harmful as this fictitious science with its accursed fertility.”

    Kant (cited by Popper as a motto of his “Open Society and its Enemies”)

  24. Based on the first three paragraphs, I thought the paper was a hoax.

    Although I wondered, if the paper were translated into English, might it yield a reasonable critique of Thomas Kuhn?

  25. Both Deleuze and Guattari where extremist communist nutters. It’s not difficult to see why they didn’t like anything based on evidence.

    Funny enough Deleuze was called “Enemy of the people” by a colleage (Badiou) who leaded a maoist-group. Deleuze was regularly terrorized by them.

    The department where they lectured (headed by Foucault) was banned from giving out diploma’s. This was done after one of their members (Judith Miller) declared “that she would do everything she could to make it run as badly as possible” and she handed out diploma’s to people she met in a bus.

  26. Our host has mentioned the paper. I think quoting para one of the abstract is useful.

    “This article examines the treatment of the pelvis in the Pilates exercises “Single Leg Stretch” and “Leg Circles.” The teaching practices of the hips, as commonly explained in Pilates educational manuals, reinforce behaviors of a noble-class and racially “white” aesthetic. Central to this article is the troubling notion of white racial superiority and, specifically, the colonizing, prejudicial, and denigrating mentality found in the superiority of whiteness and its embodied behaviors. Using the two Pilates exercises, I illuminate how perceived kinesthetic understandings of race in the body may be normalized and privileged. By examining the intersections between dance and Pilates history, this article reveals the ways embodied discourses in Pilates are “white” in nature, and situates Pilates as a product of historically constructed social behaviors of dominant Anglo-European culture.

    https://www.cambridge.org/core/journals/dance-research-journal/article/div-classtitlethe-pilates-pelvis-racial-implications-of-the-immobile-hipsdiv/2CDDDB16BFD648003DCAB3DD0634FF81#

  27. I think a little context is in order here. As ridiculous and disgusting as the article was, the journal published a number of rebuttals in the same and subsequent issues. Jefferson’ letter to the editor, in particular, utterly demolished the article with masterful succinctness. Fortunately, Jefferson’s letter, which is behind the journal’s paywall, is available on this random website, which is totally random.

  28. What I find rather odd is this from the list of authors:

    Amélie Perron RN PhD(Cand)[emphasis added]

    I’ve been doing research for a while (not as long as PCC though) and I’ve never seen an author listed as a PhD Candidate (I assume this is what “Cand” to mean) in the author list of a publication.

    Either you’ve got a degree or you don’t.

  29. It’s GOTTA be a hoax. Just look at this quote:
    “The mastery of scientific Newspeak is, for the most part, a regurgitation of prefabricated formulas (buzz words or catch words) that is informed by a single, powerful lexicon. ”

    And this is EXACTLY what the paper was doing with pomo Newspeak. My buzzword meter (aka bullshit detector) was way into the red and banging against the stop by the end of the first paragraph.

    Sheesh. Do these turkeys have NO self-awareness?

    cr

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