Saturday, August 26, 2006

Cochrane, EBM, and fascism, continued

Related to the article I talked about in this post, "Deconstructing the evidence-based discourse in health sciences: truth, power and fascism", Ben Goldacre of the Guardian follows up on an earlier badscience post about the article with another entry, "Archie Cochrane: 'Fascist'."

Excerpt from Goldacre's commentary on the article and on Archie Cochrane:
"...the argument of this paper – bear in mind it’s not an easy read - seems to be that: evidence based medicine rejects anything that isnt a randomised control trial (which is untrue); the Cochrane Library, for some reason, is the chief architect of this project; and lastly, that this constitutes fascism, in some meaning of the word they enjoy (28 times)...

Now firstly, they are plain wrong about the Cochrane Library (which simply produces good reviews of published literature): it does not only use trial data, as they claim, and it is spectacularly ignorant of them to suggest otherwise.

But there is a more important general issue here. Evidence based medicine is widely perceived as being soul-less, and algorithmic: the last thing we’d want from doctors. This is a foolish misunderstanding. EBM is about using quantitative information, in concert with all other forms of knowledge, sensibly, in a clinical context. It does not denigrate other forms of knowledge, like clinical experience or patient preference. It is not about being an automaton. I believe you humanities graduates would call that a “straw man” argument.

Well that’s all a bit sensible: how about some more childish attacks, ideally involving fascism? Okay then. I will wear their label of “fascist” with a cheeky grin. But Archie Cochrane, on the other hand, pioneering epidemiologist, inspiration for the Cochrane Library, a prisoner of war for four years in Nazi Germany (“the main reason for my capture was my inability to swim to Egypt”) who has, from his abstracted position, probably saved more lives than any single doctor you know, might see it a little differently, since in 1936, he dropped out of medical school and travelled to Spain to join the International Brigade, where he fought genuinely violent totalitarian oppression, the fascists of General Franco, with his own two hands. Now. What did you do with your summer holidays?

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