Iona Heath has just published a very well crafted piece in the BMJ …..
critiquing preventive EBM’s ‘ludicrous’ claims for efficacy, and calling for more patient awareness of life’s intrinsic uncertainties, and calling for more ‘humanity’ – attention to those parts of medical practice not captured by the biomedical science map. I fully endorse these ideas and as a GP myself for over 25 years have witnessed and accompanied folk on those non EBM-calculable lives.
What is interesting is that she alludes to the value of non-biased EBM, as if this is a possibility. But isn’t this to ignore the original bias in Descartes’ Cogito, the faith in a benign God, that presumes the primacy of the ‘mind’ over the Body? This original ideological bias is what fulfils EBMs primacy over medical practice. The fundamentalism of EBM and capitalism’s desire for surplus have combined to create the destructive juggernaut we witness today.
Science is not an innocent, and language and words do not just open emotional avenues for compassion. And compassion, whilst essential, is always prey to the ideological.
In addition we need to raise medical professional awareness of capitalism’s (ideological) corrosive powers, that function through EBM, and a deeper sceptical and political perspective. If I were to suggest anything extra, it would be that medical students should be introduced to alternative philosophies, and to a primer on media literacy.
More follows, if interested see:
Capitalism is a key development in mankind’s history – and resistance to its harmful consequences must be thought through.
Science and Capitalism are mutually reciprocally supportive, and language, discourse and it’s rhetoric, represses our awareness of this.
EBM, as a scientism, embraces, as the truth, our senses’ representations of the world as ‘real’, and this blinds us to the imaginary status of our gaze on the world. It is a kind of religious faith. As such, it and its faith, is essential for capitalism to function. EBM’s faith in the validity of the calculable, is essential to the market and exchange value and hence to making profits. And the market uses EBM as a tool to generate profits. EBM’s crisis is that it is both corrupted and corrupting.
Importantly, I believe, we have available to us today a well developed philosophical construct. In this construct (developed by people such as Zizek, and Kordela, and many others, building on the work of such as Freud, Marx, Foucault and Lacan) historically, scientific empiricism and mathematical rationality have emerged co-collaboratively with capitalism, where capitalism is a particular novel modern socially pervasive and inescapable mode of production of the means necessary to our everyday existence and survival, whose essential feature is the creation of surplus value through the exploitation of waged labour.
The co-collaboration has resulted in the gradual development of a new form of collective and individual consciousness that believes in the (illusory) narrative that EBM’s aims are benevolently utilitarian, but, especially in the field of preventive medicine, as Iona and Sackett pointed out, the essential nature of ‘capitalist scientism’ is a ‘thoughtless’ faith in growth, limitless growth, in Adam Smith’s ‘invisible hand’ and the trickle down effect. In practice, EBMs aims are just as much to maximise growth, which translates into its ‘ludicrous’ claims for the efficacy of its preventive technologies, and the way, in practice, its coercively implements these.
It is good to raise awareness of life’s intrinsic uncertainties and Medicine’s limited capacity to affect these – but there is also a political battle to be fought fundamental to tackle the pervasive colonisation of medical practice by the ‘capitalist scientific’ consciousness and it’s faith in the truth of objective scientific knowledge – ‘always’ biased by Capital’s interests to create surplus value, as the dominant mode of medical practice.
It is probably unpopular, and perhaps abstract and difficult to swallow, but we may have something to learn about the mechanisms of medical excess from both Marx’s historical materialism (consciousness develops in accordance with our modes of survival), and psychoanalysis (under capitalism, the role of faith in narrative fantasies that sustain illusions of precarious precarity and immortality).
So far the arguments neglect any input from a powerful way of thinking about the way the capitalist world works.