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

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.

Evidence based practice within the complementary medicine context

“…Educational institutions, governments, health care practitioners and consumers have all embraced and legitimized the method, which is understandable since it facilitates excellence in health care on many levels. CAM has also been swept up in the tide of EBM along the way, and is now met with the challenge of scrutinizing and validating its traditional knowledge within the paradigm of the scientific method of EBM (Holmes et al, 2006). There are advantages to this shift, including the opportunity to empirically test traditional knowledge without negating the assumptions of holism and vitalism; also the opportunity to legitimize and educate the public and the biomedical community on the methodologies and epistemologies of CAM (Jagtenberg et al, 2006).…”

“…Holmes et al (2006) express an extreme view suggesting EBM's use of scientific knowledge is exclusionary and normative, verging on micro-fascism in the contemporary scientific arena. This is no reason to discredit EBM; rather it points the way to develop and expand the epistemology of science, including phenomenological and experimental data (Baer, 2004).…”

Patients at the Centre: Methodological Considerations for Evaluating Evidence from Health Interventions Involving Patients Use of Web-Based Information Systems~!2009-08-03~!2010-01-12~!2010-09-14~!

“…The persistent claims that RCTs are the 'gold standard' of health intervention evaluation results primarily because of the dominance of the scientific research paradigm within which healthcare exists [11]. RCTs merely reflect good experimental design, however there are many potential shortcomings in the design and implementation of RCTs [9,10].…”

Perspectives on Evidence-Based Healthcare for Women

“…[3][4][5] It is perhaps puzzling, then, to come across critical perspectives (typically arising from the humanities and the more theory-driven social sciences) raising concerns about a seeming technogovernance being introduced by this deferral to the evidence where power interests can be obfuscated by way of technical resolve. 6,7 The critics holding this minority view argue that technological solutions to problems of knowledge and practice cannot replace medicine's normative content. Against EBM's democratic leanings toward transparency and accountability, medical criteria alone cannot decide valueladen ethically charged decisions.…”