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A Postmodern View of Evidence-based Medicine (EBM): Barthes. Heidegger, Deleuze and Guattari, and Derrida.

Brian Walsh


The language of an EBM paper screams objectivity. The personal interests of the authors are skilfully expunged. These are men and women of science! Taken out altogether are the drivers of the project—desire, interest, professional advancement (surely not money). The EBM paper presents an image. My paper interrogates the objectivity of the subject-object distinction, arguing that it is based on the subject, from Descartes, “I think, therefore I am”. The subject-object distinction, fundamental to science / EBM, is not used by Martin Heidegger. He depicts people immersed in the environment, coping, they hope. Their world is a world that matters, a world of joy and sorrow. Absent is the contrived distinction between subject and object, yielding a detached, “objective” universe, set up for scientists to study and gain knowledge of. Deleuze and Guattari do not read an EBM paper to ascertain its meaning. Rather they analyse how meaning is set up. They would note how the conceptual structure and language created an experimental subject depicted in biomedical terms. They would note the use of fixed terms, fossilised, such as experimental subject, rather than as a continually evolving process. Derrida tells us that, although God and metaphysics have been pushed off the conceptual cliff in out scientific age, we still read with misty, metaphysical eyes. We read in the myth of truth, based on origins and centres, about the realuniverse. We read in the coherence of the paper, and the reliability of reason. We think that words have fixed meanings, and that all readers understand the same as all authors intend.


Evidence-based medicine; EBM; subject-object distinction; death of the author; Heidegger; Deleuze; Guattari; Derrida

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