Of course, there are many valid critiques to the way in which the medical establishment does it’s business, perhaps starting with the fact that it is a business. However, in my view, the last thing we should do is to pay any serious attention to a post-modern critique of medicine, or science, or literature for that matter. It is a bankrupt philosophy that substitutes cleverness and obfuscation for clarity and honesty. In my experience living in the Bay Area, other “ways of knowing” are usually a substitute for the hard work of actually proving something.

In order to find out whether or not a given treatment works, researchers have to obtain evidence. That evidence should be as reliable as possible; as in, if I take this drug it is likely to make me better. It should not rely on what we want to be true, but is what is actually happening. We should not draw broad conclusions based on a limited number of cases, because there is a great deal of variation in all biological systems and there are exceptions to every rule. Conclusions based on that evidence should be drawn based on an awareness of statistical probability so that we avoid being fooled into seeing patterns where there are none. Conclusions must always be tentative and should be altered based on new, more reliable evidence. Given how little we know about complex biological systems, broad, overarching theories should also be avoided, since they are almost certainly wrong.

Now all of these statements seem to me to be reasonable, practical and even obvious. Insisting that people who make claims about medicine follow their guidance is no more “fascistic” than are traffic laws. There simply is a physical and biological reality that makes certain demands on those of us that want to understand it, and medicine will never progress unless we understand more about our bodies and how they work. It’s just that simple. Now, having said that, it also should be clear that, since we really don’t know nearly enough about biology, we should accept that evidence based medicine will always be deeply flawed. We will often be wrong, and this will cost lives. But the alternative, to abandon an insistence on evidence, would cost far more lives.