Why Politics and Evidence Based Health Sciences are stuck in an age of barbarism

Our subjectivities and public sentiment towards political policy, and scientific technology are in thrall to the discourse of pragmatism:

This denies our freedom to choose other voices.

Three main political discursive forces are at work:

1. The underlying philosophy of radical empiricism, so-called liberal humanism, and the view of the human as master of his own thoughts, values and destiny

2. The trenchant right-wing critique of the idea of ideology (itself ideological of course),

3. The idea of limitless scientific innovation in the search for solutions as necessarily a ‘good thing’ for humanity,

These three forces have all negated political and scientific potential to prioritize individual autonomy of decision-making and therefore the potential for these decisions to be part of work to benefit the community, so to speak.

Radical Empiricism is a philosophy that is more likely to be believed by, or at least to encourage or even justify the beliefs and values of, individual libertarianism, ultra right wing fanatic and perverse narcissistic psychopaths inclined to totalitarian and fascist polities. As opposed to say, communitarian libertarian polities. But, at the same time it can be used to justify authoritarianism if either a left (ostensibly communitarian: promoting re-distribution of wealth) or right-wing (ostensibly individualist: promoting individualist wealth ‘creation’) politics.

Quote from James 1904 on radical empiricism:

“the only things that shall be debatable among philosophers shall be things definable in terms drawn from experience”

This effectively bans debate on the role of imagination and fantasy and of social structure constituting values and thoughts. And, for James, this is sufficient for a world view.

“a given undivided portion of experience” (1912) … “figures as a thought”

a ‘thick’ description of experience being subjective and objective simultaneously.

“Being pragmatic” as opposed to ideological is sometimes used as a selling point to attract voters by politicians. However, it is actually very poorly disguised code for being conservative, which today in the UK, means being right-wing. It also, denigrates the concept of ideology or ideological critique as if ‘being ideological’ implies an incapacity to be flexible to make compromise which is nonsense.

Being ideological can encompass varying degrees of commitment to this or that dogma.

The terminology is confusing – here is a brief primer:

Many conservatives of an individual libertarian persuasion (in general politically selfish and elitist in outlook) are ‘liberal humanists’ and ‘anti-woke’,

which means they conceive of the individual as a sovereign autonomous decision maker with an unchanging human nature.

Consider the contrast between materialism and idealism:

Materialists (Lacanians and Marxists and other post modern critical theorists) believe in ideology creating fantasy and using imagination through socio-economic structures as the basis for human subjectivity: the determination of ideas and values and desires.

On the other hand, by contrast, idealists (the individualist libertarians and pragmatic liberal humanists) believe the sovereign, autonomous and rational individual mind of modernity is the basis for human identity.

Historical materialists (such as Marx) believe that social structures necessary for survival shape human thought and values, and for example make waged labour appear not just necessary but legitimate and just.

Idealists (as opposed to materialists) such as Hegel, believed that it is thought and ideas that (progressively) change the material world and not the other way round. So, radical empirical pragmatists are idealists who think their thoughts on both: a)choice of target problem; as well as b) of proposed solution, will provide a progressive advance for humanity in general. They choose a specific target problem, and outcome, think of a solution, see that, as radical empiricist, as a thought, as good as empirical evidence and justification for action , and so treat that solution as an effective truth and put that solution into operation – regardless of collateral harms or unintended consequences.

For example this radical empirical pragmatic approach endlessly proliferates (profitable) technologies for earlier and earlier diagnosis of cancer regardless of harms and over diagnosis.

Being ideological isn’t something any individual has a choice about. It means that every individual’s values and actions are to a large extent determined by cultural upbringing and whilst choices are possible, and there is agency, this is always constrained within existing social or cultural limits. Ideology as a determinant of values is the only plausible explanation for the astonishing phenomena of recent and contemporary barbaric fascism as exercised, for example, by states such as Israel. By claiming to be pragmatic today a politician is always necessarily already being ideological and exposing his or her obeisance to a culture of right-wing conservatism that favors entitled elitism, nationalism, competition, politics of envy, and resists wealth re distribution (socialism), and adequate public welfare for those in need. His or speech is performative in the sense that it demands similar obeisance from others to. It is a master discourse in Lacanian terms.

“Being ideological”: For practitioners and influencers, note that being ideological is a derogatory idea used to discredit critique based on Marxist theory. Marxist theory – alongside what is known in general as post structuralism – claims that the psyche and our conscious values are directed constructed by society’s economic framework for survival – and provide fantasies for social identities that value profit over re-distribution of wealth.

So far, so good.

The critique of neoliberalism by Marxism and post-structuralism suggests that, within contemporary social structural constraints at least, it is possible to find other values, and other effective truths (knowledge sufficient to guide action to achieve certain target outcomes).

The dominant contemporary 2022 paradigm for humanity and its knowledge, epitomized by EBM and evidence based public health care and purchasing, most crucially implicitly (and quite silently) denies any ideological basis to human thinking capable of finding and using knowledge, as effective truths, to guide action. To put this differently, the Marxist approach to ideology (which includes the notion that we are always all inevitably being ideological) encompasses the notion that there are, confusingly, material influences that can determine our basic ideas in terms of our values and thoughts – what has been called (historical materialism). The key point is that contemporary dominant scientific knowledge creation claims to be able to avoid being ideological, and that its praxis (being pragmatic according to conservative values in the quest for power/profit/innovation/solutions to profitable questions) can safely assume the public can also avoid being ideological. That is, it assumes scientific knowledge creation and the public and individual capacity for decision-making can proceed as if independent of material social structures and circumstances.

This then is why ‘being ideological’ is code for being anti-social and Marxist, and prone to delusional thinking about knowledge and the possibility of so-called multiple truths.

However, my Marxist and Lacanian, claim that it is only by considering the human psyche as inevitable ideological: constructed in terms of its values and the things it knows and other things if appears not to know, that we can begin to provide a plausible explanation for the surprising, frightening and horrifying, spectacle of humanity’s capacity to inflict so much cruel barbarism on so much of the human population. Only by thinking of the psyche as able to be in apparent total denial of the value of the lives of ‘certain’ others can we begin to explain the barbarism that abounds in the world.

Applying these ideas to the medical-industrial complex and it’s search for prevention through screening:

For example, leaving global politics, apartheid, immigration policies, destruction of public services and austerity aside, at a more mundane level, it is how we could plausibly explain, at a psychic level, why official (political) scientific advice and public sentiment feels able to pursue population-based diagnostic screening programs such as breast cancer screening that causes so much direct harm, so much over-diagnosis, and still leads to a failure to reduce all-cause mortality despite reducing breast cancer deaths, (with the logical conclusion that screening must cause deaths from other causes, plausibly from surgical intervention or mammography, radiography).

So, to summarize, the best explanation for the hyperbolic growth in a destructive politics of neoliberal capitalism, and for example iatrogenic harms due to over-diagnosis, lies in psycho-political theory based on the ideas of Marx and Lacan. These suggests all human thinking is necessarily ideological. That it, the values we hold as ‘normal’, and take for granted, are those absorbed in childhood via our cultural norms. And today these are predominantly the values of free market capitalism with its competition, greed, narcissism and violence polluting the global psyche en masse. In certain psychoanalytic theory (Lacan) the individual’s identity or sense of self, it’s ‘I’, is the consequence of the child’s need to escape its lack of identity with which it emerges into the world. And it can only escape this intolerable subjective lack or void by turning to the command and language of a powerful other, by surrendering power to this figure, to gain identity through the acquisition of certain socially normative values, at the expense of other values which are rendered unknown or unconscious. The usual human state is one of being neurotic – in the sense that this identity always only feels partial, resulting in a constant desire for affirmation though more subservience or, in a more hysterical mode of subjectivity, to question the voice of normative power and to seek other powerful voices. The key point here being that the human must always have a voice of power to listen to and to be watched by in order to sustain even a minimum of identity (subjectivity or sense of self).

Having got this far we should return to the relevance of this ideas and theories to the basis and praxis of EBM, or other proposed complex models for determining how knowledge should guide public health care. The relevance is that a) current models are, contradictorily, already being ideological by denying ideology by denying the psyche is constructed to have certain conscious values by the social structure of capitalism that expose lack, create desire, which leads to an apparently autonomous demand to be able to consume products such as anticipatory diagnostic healthcare screening; and b) this denial enables the continued hyperbolic proliferation of techniques for marketing mass diagnostic screening methods; and c) perversely, (a term I use advisedly), even enables scientists to use the dogma of EBM, and it’s reliance on experimental empiricism (and it’s gold standard, the RCT) to critique policies to reduce the spread of Covid through eg mask mandates or economic lockdowns such as closing theatre and cinema and parks and advising work from home etc. This is a tendency by a right-wing individualist-libertarian trend that is consistent with an extreme idealist philosophy that claims that not only is the individual autonomous of social structure but: a) the individual’s thoughts can be considered just, as if not more, valuable than otherwise empirical evidence for determining knowledge to justify action to tackle ‘chosen’ (for their surplus profit and power potential) particular problems; and b) the pursuit of the (superior and most evolutionary useful and productive) thoughts of powerful elites to guide political actions is by definition progressive and advantage for nature and humanity (even if it means destruction of large swathes if the world and its populations). There is an interesting conundrum that emerges – it is as if the EBM enthusiasts are using a preference for experimental empiricism to further the project of individual libertarianism which actually values elite and individual thought as the best empirical guide to political policy.

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