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  Apr 11, 2012                  

DSM-5: What is "evidence-based medicine"?

I only found out in 2009 how much, how awfully and how dishonestly people with my disease - ME/CFS, that I now have since January 1 1979, and that is much worse then it was the first ten years - have been slandered, defamed, and have had their personal character, honesty and integrity besmirched by psychiatrists and clinical psychologists as if that is a matter of course for folks with this kind of education.

This happened on the basis of the pretense - the lie, the deception - that ME/CFS, which is a disease with an  unknown cause, admitted as such since 1969 to the present day by the World Health Organization, must be a form of... madness, according to psychiatrists and clinical psychologists, and also according to bureaucrats who want to save on dole or medical support and according to insurance-companies who want to shift the blame and the costs onto the victims of this and other so far unexplained diseases.

It also happened mostly in the name of "evidence-based medicine" - a concept conceived by the same class of persons who slandered and defamed myself and millions of others as a matter of course, as if a psychiatrist who has never seen or met one should be completely free to slander ill people, to the effect that they are mad, thereby knowingly making it impossible or very difficult to get any help for having a disease, merely on the strength of his degree and some nonsense he has fictionalized into being, while actively trying to achieve that his own kind of nonsense gets adopted by insurance companies and governments who all want to cut costs and are not averse to abusing mere speculations for that, and also reserving millions of ill people as ready cash cows for psychiatrists who insist they are not ill but mad, and "deserve" the "professional care" of their kind.

Before turning to the riddle in the title - What is "evidence-based medicine"? - let me note that I have now received no help whatsoever, except minimal dole accompanied with decades of bureaucratic discrimination (*) for the 34th year in succession; that I have excellent university degrees in psychology and philosophy; and that I had hoped to get into university as a philosopher of science or as a logician; and that I consider the cognitive claims of most anyone about most anything in logical or methodological terms, that the reader may learn more about here:

On natural philosophy, philosophy of science, and psychiatry

It's also only since ca. 2009 - when I got fast internet: Before that I had only a slow and flaky telephone-modem for almost 13 years - that I learned of the vast popularity of the phrases "evidence-based medicine" and "evidence-based science" amongst psychiatrists and clinical psychologists - not among real scientists! - which anyway are two "sciences" of which the academics take the greatest liberties with scientific methodology, that indeed also seems hardly known by this breed of academics: They do not know about logic or methodology or philosophy of science, but they pretend to know all about the cognitive and rational reasons that would allow them to lock you up if you protest too much against their pseudoscience and their false pretensions to understand the human mind.

My immediate reaction was they must be mad, stupid or else engaging in PR ("PR" as in "public relations", and the last link is quite helpful):

After all, anyone sufficiently intelligent to enter a university knows what a pleonasm is?! Only singers of country music, and folks with IQs below 75 write texts in which dark nights, white snow, red blood and hot fires figure as a matter of course?! Everybody who studied in a university knows that something that is not based on evidence cannot be science?! Right?

Wrong! Here is why.

I realized since discovering the prevalence of the phrase "evidence based" in the writings of pseudoscientists that the situation is considerably worse than the nauseating practice of systematically inserting the lie that psychiatry and clinical psychology or that such and such work in these fields Ôs - somehow, in a never properly clarified or explained sense - "evidence based", which in fact they are as little as astrology and theology are "evidence based sciences":

These last two pseudosciences also appeal to - purported or real - facts, but are pseudosciences because there is no proof that their supposed objects - planetary influences on one's chances and character; the divinity that made all; one's sinful nature that Jesuits can prove made one ill etc. - exists or indeed can be investigated with real scientific means, that involve explicit hypotheses and careful factual tests of these, and repeatable experiments.

Likewise, in psychiatry and clinical psychology there is talk of facts, but not as in the real sciences, such as physics and chemisty. Here is the difference in a diagram that explains what "evidence-based" really means: A return to the days before Galileo in methodology:

In real science there is an explicit hypothesis, that is, a theory that goes beyond the facts it attempts to explain, and from which one can logically deduce a prediction, which one can then test by some experiment, to see whether it is supported or contradicted by properly established facts.

In pseudoscience, medieval theology, psychiatry, astrology, and clinical psychology it is different, since the last three decades or so:

While the academic researches in the mentioned pseudosciences pretend they are doing real science (with lots of statistics, with p-values, with accuracies of many decimals after the dot etc., all to make it look "scientific" and make it very hard to see through by laymen as what it is: fraudulence) and deign not to discuss philosophy of science, methodology, real statistics or logic, in fact what happened is that they inverted matters as shown in the diagram.

What they do is this, for the most part: They do some sort of statistical simplification of whatever they research, for example, by taking random samples that they than declare falsely to "represent" the population; pour these data into tables with numbers with decimals and some statistical terms; and then use these reductions, simplifications, obfuscations and misrepresentations of their field as the basis of what they call "evidence-based" science, which then accordingly is rife with the phrases like "may", "suggest", "may suggest" and so on, knowing full well they are making play pretend games, but only very few of their victims and very few of their academic colleagues will protest, and being vague in language - but firm without any factual in proposing policies based on their pseudoscience - helps them much not to be found out.

So that is what "evidence based science" and "evidence based medicine" really are:

Travesties of scientific methodology, that make proper testing impossible, and that replace real science with a real and logically based methodology where theoretical hypotheses are tested by careful experiment, by pseudoscience without proper tests (**), and were the whole logic of science, which is deductive and mathematical, and may involve probability, has been replaced by a pseudologic of science which is no longer deductive but - at best - inductive, in Frances Bacon's sense (***), and where the testing of hypotheses has been replaced by the formulation of arbitrary guesses on the basis of ill or dishonestly prepared, dishonestly presented or methodologically unwarranted "facts".

And that seems to me the reason for this phrase "evidence based" in the writings of pseudoscientists like psychiatrists and clinical psychologists:

It is both intentionally misleading PR-talk, designed to mislead, confuse, and obfuscate, and it is a - for some, none to bright clinical psychologists, for example - possibly sincere insistence on what is in fact a travesty of scientific methodology and a return to the medieval way of doing science: By hunch, by prejudice, by incarceration of dissidents, by pretense, without proper experiments, without real hypotheses rationally tested, and all manufactured, defended and spread by peer review of like-minded similarly ill educated folks with the same financial interests in lying for money or for a career and with the same outlook and education, that will support almost any bullshit that sounds like their own preferred style of bullshit.


(*) In fact the vast amounts of discrimination I received from  Amsterdam bureaucrats and politicians (that all may be safely assumed to be prominent members of the Dutch Labour Party, for things are de facto regulated in Amsterdam that way since many decades: The grandees of Dutch Labour 'owe' Amsterdam as nobility 'owed' Burgundy in the Middle Ages, and almost only nominate members of that party as their trusted, loyal, local servants.

For example, I have been threatened with murder by bureaucrats from the dole, because I dared to their racism to others, in my presence; my mother was called 'a dirty cunt-whore' at the same occasion; nobody denied it had happened, but my many letters about it were never answered, and I was told that the bureaucrats thought I must be a homosexual because I wear my hair long, and that since I wasn't I had nothing to complain about. The bureaucrat who told me that had the name Van Heemskerk: I protested, and my letters were never answered and systematically destroyed instead. 

Finally, if other Dutchmen tell you I must be "exaggerating": No, I am not and in fact have left out a lot more discrimination. The reason I ran into it is that I am uncommonly gifted, also verbally, and not at all afraid, which probably is genetic, since my father, mother and grandfather were heroes of the Dutch Resistance against Nazism, something that very few Dutchmen - almost only communists, like my parents and grandparents, of Christians of the more extreme Calvinist churches - had that courage.

(**) Some statistical tests are being done, even  by psychiatrists. Here too the pseudoscience of psychiatry does never get refuted, and the tricks for this feat of "scientific irrefutability" are mainly these:

First, the field to be studied is systematically obfuscated by misdefinition, such as identifying - now in its 25th year of being practised! - ME/CFS, that has ever since the 1960ies a fairly precise medical definition that originated in dr. Ramsay's work, with nothing else than "unexplained fatigue for some time" or something similar, and then "research" that by random sampling - which is like studying poliomyelitis by identifying it with "has difficulties walking for some time", and then do random samples on people who have difficulties with walking, and use this as "the scientific data" for the study of poliomyelitis.

Second, one is implicitly forbidden to doubt or question the honesty, adequacy, rationality and methodology of the ways these psychiatrists and clinical psychologists gather their "scientific data". For example, when the psychiatrist professor Wessely gives blood to the retrovirologist professor McClure, one must accept by a similar act of faith as establishes the presence of God in the water a priest sprinkles over his congregation that if professor Wessely says this is blood "from patients with ME/CFS" this must be true, and doubting it simply is not done.

Third, when reporting such "statistical tests" as has been done on what are - also in psychology in general, by the way - almost always methodologically very doubtful data, especially psychiatrists and clinical psychologists take the greatest liberties with what manner of test they use (often not the right ones, for statistically or methodo-logically educated people); with what parts of their data they reveal or keep secret; and with what conclusions they attribute to their "experiments".

If you ask at this point why hardly anyone seems to care, the answers are that (1) the techniques of peer-review imply that their very own friends and colleagues, raised in the same tradition as they are, are quite willing to pass most anything that looks to laymen as if it may be "evidence based science" and (2) the proportionally few rational and sincere psychiatrists or clinical psychologists who see the problems I sketched risk their own careers and their own tenure if they publicly doubt the techniques or sayings of what count as "the leading lights" of their field, also if these are, in the eyes of real scientists, hardly better than fraudulent, bullshit, or at the very best ignorant wishful thinking.

(***) That is: Not even in Mill's sense, who had the merit of trying to articulate canons of induction.

Corrections, if any are necessary, have to be made later.


As to ME/CFS (that I prefer to call ME):
1.  Anthony Komaroff Ten discoveries about the biology of CFS (pdf)
3.  Hillary Johnson The Why
4.  Consensus of M.D.s Canadian Consensus Government Report on ME (pdf)
5.  Eleanor Stein Clinical Guidelines for Psychiatrists (pdf)
6.  William Clifford The Ethics of Belief
7.  Paul Lutus

Is Psychology a Science?

8.  Malcolm Hooper Magical Medicine (pdf)
 Maarten Maartensz
ME in Amsterdam - surviving in Amsterdam with ME (Dutch)
 Maarten Maartensz Myalgic Encephalomyelitis

Short descriptions of the above:                

1. Ten reasons why ME/CFS is a real disease by a professor of medicine of Harvard.
2. Long essay by a professor emeritus of medical chemistry about maltreatment of ME.
3. Explanation of what's happening around ME by an investigative journalist.
4. Report to Canadian Government on ME, by many medical experts.
5. Advice to psychiatrist by a psychiatrist who understa, but nds ME is an organic disease
6. English mathematical genius on one's responsibilities in the matter of one's beliefs:

7. A space- and computer-scientist takes a look at psychology.
8. Malcolm Hooper puts things together status 2010.
9. I tell my story of surviving (so far) in Amsterdam/ with ME.
10. The directory on my site about ME.

See also: ME -Documentation and ME - Resources
The last has many files, all on my site to keep them accessible.

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