Evidence-based medicine or micro-fascism?

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 (180).

Not my words, but those of Dave Holmes and Stuart Murray in their fabulous paper Deconstructing the evidence-based discourse in health sciences: Truth, power and fascism.  The author’s argument is that we desperately need to unmask the ‘the hidden politics of evidence-based discourse’ (181).

A recent Australian report on the efficacy of homeopathy (link) has shown that “There was no reliable evidence from research in humans that homeopathy was effective for treating the range of health conditions considered,” and that “Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious.”

And yet, according to Vox, Americans spend more than $34 billion each year on ‘alternative’ medicine each year, with $3 billion going on homeopathy.

You might argue that this is a call for more evidence-based research and greater efforts to convince the public about the efficacy of treatment A over treatment B, but I’m not sure it doesn’t point to a bigger failure of the evidence-based medicine movement to convince the public that medicine still holds the answer to the population’s health.

In what must be one of the most comprehensive and most scathing editorials ever written, Andrew Miles and colleagues take the advocates of evidence-based medicine to task.  They argue that evidence-based medicine is intellectually bankrupt and overdue retirement.  They acuse protagonists of EBM of unscientific and antiscientific posturing in an attempt to ‘protect the cherished ideological convictions of the EBM community’ (621), or showing ‘the magisterial disdain of criticism that we have noted on multiple occasions previously and which more accurately characterises the modern politician than the intellectual’ (621).  Advocates of EBM are, they argue;

…extraordinarily lacking in intellectual credibility, are profoundly revisionist and demonstrate that little has changed in terms of EBM’s ideology or hubris with the exception of an increase in self-delusion and a refusal to accept that EBM is ‘finished’ in scientific, philosophical and clinical terms (622).

References

Holmes, D., Murray, S. J., Perron, A., & Rail, G. (2006). Deconstructing the evidence-based discourse in health sciences: Truth, power and fascism. International Journal of Evidence-Based Healthcare, 4(3), 180-186.

Miles, A., Loughlin, M., & Polychronis, A. (2008). Evidence-based healthcare, clinical knowledge and the rise of personalised medicine. J Eval Clin Pract, 14(5), 621-49. doi:10.1111/j.1365-2753.2008.01094.x