Medicine – from Saul Alinsky to EBM


by James Higham
http://www.4liberty.org.uk/2011/11/22/medicine-from-saul-alinsky-to-ebm/

There is SeanGabb’s view, of course [H/T Revolution
Harry
]:

“Something we should leave substantially alone is the welfare state. The main assumption behind which the Enemy Class justifies its looting of the taxpayers is that any cuts in public spending must fall on the welfare budget. Of course, it is a false assumption, but it does not help that libertarians have always made a great noise about the corrupting effects of state welfare, and that libertarian schemes of improvement always give prominence to privatising or abolishing it. This shows a failure of political understanding.

All else aside, it would be madness to give the Enemy Class an issue on which it might claw its way back from oblivion. It may be regrettable, but most people in England like welfare. They like the thought that if they lose their jobs, they will receive some basic support, and that if they fall ill, they will receive treatment free at the point of use. That is what is wanted, and that is what a government of the right must continue providing.

It need not actually be very expensive. Most people would rather work than claim; and in a free economy, there would be no lack of work. As for the National Health Service, the main expenses here come from structures that currently exist only to divert funding to or through the hands of the Enemy Class. Strip these out, and the costs might come substantially down.

I would suggest privatisation of all medical services—though paid for by the State, these do not have also to be provided by it—and radical deregulation of all the medical professions: such regulation does not work, and never was intended to work, in the interests of patients.”

The essential point, which Statists don’t quite get is that the State has been hijacked, with all sorts of nasties floating about, e.g. Common Purpose – this is a starter on this organization for those still unaware and as they point out:

Common Purpose is also the glue that enables fraud to be committed across these government departments to reward pro European local politicians. Corrupt deals are enabled that put property or cash into their pockets by embezzling public assets.

It has members in the NHS, BBC, the police, the legal profession, the church, many of Britain’s 7,000 quangos, local councils, the Civil Service, government ministries, Parliament, and it controls many RDA’s (Regional Development Agencies).

There is a self-actualizing tendency among many people to automatically assume that because it is all printed on official looking paper and is bureaucratically administered, then it must be above board and not corrupt. See EU Referendum and Captain Ranty for tales of just how uncorrupt it is.

In the case of CP, there is chapter and verse on the matter – difficult to get hard data because the organization is so secretive. See here and here and here and here [mid post quote] and here, just for starters.

And then there is the dumbing down in which they’re involved [admittedly late on the scene].

If you look closely at the words Sean uses, they include “I would suggest” and ”in a free economy, there would be”. How many blogs have you read things like “this could be” or “if only this were done”? And then there is the line: “This shows a failure of political understanding.”

The problem is that there is an entrenched and committed agenda designed to maintain the status quo of the new social engineering and it’s not just a case of something being considered and adopted – it’s necessary first to blast out the opposition by showing it for what it is and that in itself raises certain problems.

Plus everyone’s telling everyone else that they don’t politically fully understand and they come at it from their angle – mine is to lump all these nasties, from CP to the IMF and JPM, as Them and maintain, as Sean does, that there really is an Enemy class but it includes bodies such as the CFR and TLC, Force Femmes, the ECB [everyone includes them], Tavistock’s successor and so on.

Some even get that far and then stop when it starts getting onto the quasi-religious aspects of Them, especially noticeable in the green movement and the climate guff:

http://wattsupwiththat.com/2011/11/22/climategate-2-0/

http://noconsensus.wordpress.com/2011/11/22/climategate-2-0/

http://motls.blogspot.com/2011/11/climategate-2011-foia.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+LuboMotlsReferenceFrame+%28Lubos
+Motl%27s+reference+frame%29

The thinkers behind it who are quoted by the left – well, I shake my head at how melodramatic the baddies really are. If you read Marcuse and Alinsky, for example, even Russell and certainly Huxley, the overwhelming question is why? Why do they wish to destroy society that way? And the next question – why would anyone follow them?

You could answer the latter easily. They use feelgood terms and concepts in such a way that the average left-liberal really believes he/she is supporting good, that the moral high ground is on his/her side and all the rest are narrowminded, selfish people intent on stopping the great movements from eradicating poverty and so on.

The terminology and abuse of this terminology is addressed here.

When someone is totally convinced his/hers is the only way forward, as the ideological underpinnings of our socialist state make you convinced, then no amount of evidence of just how corrupt and unworkable that view is will make the slightest difference – you’ll fiercely avoid any literature showing this and concentrate instead on your own literature, whilst accusing people like myself of quoting only my own kind of literature.

There are blogs everywhere [many are quoted here, many at my
place] which painstakingly look at the leftist utterings and deconstruct this post or that – it’s a time-consuming business. And it’s worse when the moves are so subtle that the average person is going to be so engrossed in his/her own daily living that he/she’s not going to pick up on these things, unless they’re pointed out and that in itself presupposes that these blogs will “fall into their hands” and that, even if they do, the person will read with an open mind.

Take Saul Alinsky and his idea:

… that it is permissible, even noble, to blatantly lie if that lie advances the greater truth and so helps concentrate power to the hands of the enlightened and right-thinking people. In this light, the recent news about that Dutch social psychologist who simply falsified data to produce the desirable results that he wanted really ought not to be that surprising. Now, social psychology is a field that you rarely see mentioned in media otherwise, but something in there now rings a bell… damn, what the heck was it… ah yes, that speech “Post-Partisan Social Psychology” by Jonathan Haidt where he noted that the entire field has become a tribal moral community and a partisan echo chamber that intentionally rejects not just conservative ideas but conservative people, and suppresses in lockstep all problematic questions and data about liberal shibboleths such as race and gender.

I ran posts on the psychiatric community, via a Colin Ross interview, on my old blog and it said precisely what Jonathan Haidt is now intimating.

EBM

One area where power has shifted is in the field of medicine and Bruce Charlton is known for bringing this to everyone’s attention, having been involved in the field of epidemiology for a long time. Here is a more complete coverage:

http://www.hedweb.com/bgcharlton/journalism/ebm.html
http://www.rhizomeway.com/rhizomenetwork/?p=1829
http://www.brown.uk.com/teaching/HEST5001/mykhalovskiy.pdf
http://medicalhypotheses.blogspot.com/
http://www.theatlantic.com/business/archive/2011/11/the-tyranny-of-blood-levels/248681/
http://charltonteaching.blogspot.com/2009/08/zombie-science-of-evidence-based.html

Here’s his colourful opening:

Zombie science is defined as a science that is dead but will not lie down. Instead, it keeps twitching and lumbering around so that it somewhat resembles Real science. But on closer examination, the Zombie has no life of its own (i.e. Zombie science is not driven by the scientific search for truth [6]); it is animated and moved only by the incessant pumping of funds. Funding is the necessary and sufficient reason for the existence of Zombie science; which is kept moving for so long as it serves the purposes of its funders (and no longer).

So it is a waste of time arguing against Zombie Science because it cannot be stopped by any method except by cutting-off its fund supply. Zombie science cannot be killed because it is already dead.

Now, as it relates to the NHS itself [keeping Sean Gabb in mind
at the top]:

There was the foundational assertion that in the past pre-EBM medicine had not been based on evidence but on a blend of prejudice, tradition and subjective whim; this now to be swept aside by the ‘systematic’ use of ‘best evidence’. This was an ignorant and unfounded belief – coming as it did after the (pretty much) epidemiology-unassisted ‘golden age’ of medical therapeutic discovery peaking somewhere between about 1940 and 1970 [8-11].

With regard to ‘best evidence’ there was the assertion that ‘evidence’ meant only focusing on epidemiological data (and not biochemistry, genetics, physiology, pharmacology, engineering or any other of the domains which had generated scientific breakthroughs in the past). It meant ignoring the role of ‘tacit knowledge’ derived from apprenticeship. And it was clearly untrue [12-15].

Then there was the assertion that the averaged outcomes of epidemiological data, specifically randomized trails and their aggregation by meta-analysis of RCTs were straightforwardly applicable to individual patients. This was a mistake [12,
16-18].

On top of this there was the methodological assertion that among RCTs the ‘best’ were the biggest – the ‘mega-trials’ which attempted to maximize recruitment and retention of subjects by simplifying methodologies and thereby reducing the level of control. This was erroneous [12, 16, 19].

In killing-off the bottom-up ideals of Clinical Epidemiology, EBM embraced a top-down and coercive power structure to impose EBM-defined ‘best evidence’ on clinical practice [20, 21]; this to happen whether clinical scientists or doctors agreed that the evidence was best or not (and because doctors have been foundationally branded as prejudiced, conservative and irrational –EBM advocates were pre-disposed to ignore their views anyway).

Expertise was arbitrarily redefined in epidemiological and biostatistical terms, and virtue redefined as submission to EBM recommendations – so that the job of physician was at a stroke transformed into one based upon absolute obedience to the instructions of EBM-utilizing managers [3].

(Indeed, since too many UK doctors were found to be disobedient to their managers; in the NHS this has led to a progressive long-term strategy of the replacing doctors by more-controllable nurses, who are now first contact for patients in many primary and specialist health service situations.)

Cranking this down for those such as myself who are not up on medical terminology, from what I can see, the issue is this – medical diagnosis relies on a host of signs, symptoms, reference to the records, the history of the various complaints, to the doctor’s own expertise in being able to see that there might be complicating factors here.

You can’t cut out the doctor’s input and force him to only refer to state administrators’ love of having everything boxed and corralled and this comes out in my own new field, where I don’t have to think whenever someone comes to us – we have databases of “best practice” and I observed an interview yesterday where exactly that happened – the lady stated her situation and the “professional” simply referred to database notes on all the different key points and proposed a solution based on those. The lady was trying to explain other circumstances which impinged on that but they weren’t covered by the centralized database and therefore did not exist.

I saw her concerns ignored.

Bruce mentions the replacement of doctors, in the traditional sense, with robot nurses who refer only to charts and database entries.

Example from RL: A lady goes to a doctor because she has heart trouble. The doctor tells her that she doesn’t have because she’s too young – the database does not allow for that nor for complicated permutations of various conditions.

Everyone knows that in the old GP system, doctors did misdiagnose here and there and that’s why there was always a tradition of second opinion – and opinion is the crucial word here – it refers to informed opinion.

This situation no longer exists – there is the One Opinion and that changes with fashion, e.g. the recent salt debate. Now I ask you if that’s any way to run a medical service and how much taxpayer-funded bureaucracy does that entail? What sort of “doctor product” is now being produced by the medical colleges? How far is it like in education [next post] and every other field, where only the compliant who are willing to affirm the top-down “truth” are given jobs?

And if that truth is simply not complete, what then? What if you complain, rock the boat? What if you point something out? Are you welcomed?

And in education, the damage to the child shows after a generation. In medicine, the damage results almost immediately.

Sean Gabb did say that medicine should be privatized but what chance if the new dogma is EBM and the funding still comes from the State which delights in such one size fits all solutions?

More soon.

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