Evidence Based Medicine, market penetration and the sexualised fantasy of normality  

Human Sexuation is that which makes sex sexy for us, it is constituted at the interaction between nature and culture; the bottom two cells of the quadrant of Lacan’s four ( five if you include the market case) structures of discourse. These cells hold the Truth of discourse and the product of discourse. Here the truth is/becomes feminised or masculinised in its encounter and always misrecognition by the product of EBM.  In the discourse of the market under capitalism, EBM works to provide one of the products, bodily pathologised representations, for the market. The ‘truth’ of EBM is its misrecognition of this product because of the impossibility it exceeds. The truth, that may be Profit, Surplus Flesh, Surplus Life, is the misrecognition of the perception, the recognition of a ‘made to appear’ and therefore ‘evidential’ pathologised flesh, as the point of contact between nature and culture, the aporia of biological normality, an impossible yet demanded Real. The misrecognition provokes crisis – for EBM, which has to work even harder, to produce more flesh, more market penetration. So one of the ‘core values’ of EBM, that is ignored or misrecognised by the governmental practice of EBM, is market penetration. It is this that sets the limits for EBM. The diagnostic cut-offs, the test parameters set by the market to define the pathological, that determines success or failure. Success for the market demands a maximisation of market penetration and Profit and therefore of pathology.  The sexiness in the discourse of the market is of a perverse sadomasochism, the Other is still performed for, but is disavowed so that the human is thoroughly tortured as an object of bodily parts technically, but also because as human provides a jouissance through imagined suffering by the torturer, which could also be an autoerotic manifestation of self-consumption and torture.

Put simply, EBM misrecognises the products of its diagnostic processes, i.e. ‘pathology’ which warrants the existence of an impossible normal. This provokes crisis when the cut-offs applied to tests (eg low risk versus high risk) break EBM’s internal rules about the limit, and fails to maximise pathology and minimise the non-pathological. The crisis provokes more and more medicalisation and overdiagnosis.

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