William M. Briggs

Statistician to the Stars!

Is Truth And Evidence In Medicine Fascist? Update: Yes.

Dirty rotten fascists plying their trade?

Dirty rotten fascists plying their trade?

See what you think of this peer-reviewed paper by Dave Holmes in the International Journal of Evidence Based Healthcare called “Deconstructing the evidence-based discourse in health sciences: truth, power and fascism.

Is it a hoax in the same vein as Sokal’s? You decide. Here’s a snippet from the Abstract (emphasis original):

Background Drawing on the work of the late French philosophers Deleuze and Guattari, the objective of this paper is to demonstrate that the evidence-based movement in the health sciences is outrageously exclusionary and dangerously normative with regards to scientific knowledge. As such, we assert that the evidence-based movement in health sciences constitutes a good example of microfascism at play in the contemporary scientific arena.

Objective The philosophical work of Deleuze and Guattari proves to be useful in showing how health sciences are colonised (territorialised) by an all-encompassing scientific research paradigm — that of post-positivism — but also and foremost in showing the process by which a dominant ideology comes to exclude alternative forms of knowledge, therefore acting as a fascist structure

Paper goes on to complain about the Cochrane Group. Now if you don’t know, these guys are ate up (this is what we Air Force guys used to say of Marines); they run all over the place waving their wee p-values at everybody and parroting the phrase “evidence-based medicine”, in much the same fashion as some atheists call themselves “Brights.”

They’re like the guy at the bar who won’t change the subject. They are annoying and too in love with quantification. Yet you are, as a doc, allowed to ignore them—mostly. Plus, the results these guys tout aren’t always wrong (or over-confident).

Well, so what. People in medicine are always bickering about what evidence counts, so much so that it’s a non-story. But now comes this charge that truth in medicine is fascism. Can the authors really be serious? Here are some quotes (all still original).

…fascism of the masses, as was practised by Hitler and Mussolini, has today been replaced by a system of microfascisms — polymorphous intolerances that are revealed in more subtle ways…

EBHS (evidence-based health sciences)…

Rather than risk being alienated from their colleagues, many scientists find themselves interpellated by hegemonic discourses and come to disregard all others…

Those who are wedded to the idea of ‘evidence’ in the health sciences maintain what is essentially a Newtonian, mechanistic world view: they tend to believe that reality is objective, which is to say that it exists, ‘out there’, absolutely independent of the human observer, and of the observer’s intentions and observations. They fondly point to ‘facts’, while they are forced to dismiss ‘values’ as somehow unscientific. For them, this reality (an ensemble of facts) corresponds to an objectively real and mechanical world…

Obvious examples here are the hysterisation of the female body and the pathologisation of homosexuality within medical discourse…

… promote the multiplicity of what Foucault describes as subjugated forms of knowledge…

…we understand such fascist logic [in EBM] as a desire to order, hierarchise, control, repress, direct and impose limits. Fascism is one of the many faces of totalitarianism — the total subjection of humanity to the political imperatives of systems whose concerns are of their own production. In light of our argument, fascism is not too strong a word because the exclusion of knowledge ensembles relies on a process that is saturated by ideology and intolerance regarding other ways of knowing…

It is fair to assert that the critical intellectuals are at ‘war’ with those who have no regards other than for an evidence-based logic…

This reminds us of a famous statement by President George W Bush in light of the September 11 events: ‘Either you are with us, or you are with the terrorists’. In the context of the EBM, this absolutely polarising world view resonates vividly: embrace the EBHS or else be condemned as recklessly non-scientific.

I’m on the fence. There’s enough sanity here to fool you into thinking the insane parts are in earnest. But this in the Age of the Internet. It’s too easy to create spoofs.

I emailed Holmes and asked whether he was having us on, but received this (probably genuine) response. “Merci pour votre message. Veuillez prendre note que je serai absent du 29 février au 6 mars incl. Merci.”

Holmes is also the author of “Reversing Kristeva’s First Instance of Abjection: The Formation of Self Reconsidered” and many other similar titles, which is in favor of the current one being genuine. Plus, one of his co-authors, Rail, and the author of such papers as “Cancer’s margins and the choreography of knowledge: Toward a queer biopolitics and the mobilization of public health knowledge.”

So I’m going with genuine.

Update Just after I put this up, I received this email from Holmes. “It is a real deconstruction piece that we enjoyed writing very much!”

There you are: genuine.

37 Comments

  1. many scientists find themselves interpellated by hegemonic discourses…
    There ought to be a vaccine for that.

    Factual evidence in medical science is “fascist” but Obamacare isn’t?

  2. All I know is that without modern medicine, I’ve have been dead thirty years ago. Of course, without the student insurance I was forced to purchase, I’d have been still paying for my one-week hospital stay. (oh, maybe not, since I was poor, my debt would’ve been forgiven. The hospital would’ve just passed the cost to others! )

    It is a real deconstruction piece that we enjoyed writing very much!”

    Hahahahaha…

  3. In the US, government controls virtually all of healthcare, and already did so even before the ACA. My concern is that doctors can be required to follow government-approved algorithms ostensibly based on EBM, rather than treating patients as individuals. The fact that doctors are signing up with hospitals and HMOs to protect themselves from the ACA makes this more likely. Unlike independent providers, employees do as they’re told.

    An example is the reliance on statins to lower cholesterol numbers despite serious side effects, and more recently the evidence that inflammation is a better marker for cardiovascular disease. The ever-present risk from pharmaceutical companies driving research is just one concern with EBM.

    The main problem with EBM, therefore, is that its use will not be voluntary due to government compliance requirements. The excerpts from the article don’t mention that the “fascist” elements stem from the government control of healthcare.

  4. I had no luck finding the meaning of the word microfascism. I guess it means whatever one wants it to mean. Reading on in the paper, I see the authors love language that says virtually nothing but sounds really smart, or so they think.

    Jean: If we don’t use evidence, what do we use? Is it preferable to return to the gypsy tonics sold from a medicine wagon? Natural remedy providers are already out there and making billions of dollars a year. I know there was a homeopathic doctor in the town I live in. Better yet, these are completely unregulated, as long as the practioner does not actually claim the product cures a disease or at least puts a disclaimer on the bottle. The only reason to want these legitimized is to get insurance compensation—you know, the old “we want MORE MONEY” move.

    JH: Modern medicine is indeed quite remarkable and life-saving.

  5. While you’re on the topic of academic weirdness, check out this one – http://gradworks.umi.com/10/01/10010629.html – “Solving for irrational zeros: Whiteness in mathematics teacher education”

    It’s Steven Hayward’s (Powerline) “Dissertation of the Year.”

  6. Stacy Trasancos is right:

    “…science today is returning to the pantheistic, pagan, or atheistic thought of ancient times—times when science did not thrive as a self-sustaining enterprise that discovered physical laws and systems of laws, but instead viewed the world as unpredictable, unknowable, and magical.”

  7. That poor chump Newton. Imagine believing gravity is a real thing. I laugh so hard at that I fall off my chair. Wait, why did I fall?

  8. To help readers unfamiliar with the landscape of modern science:

    “Peer-reviewed” by itself means nothing (as this example shows). Peer-reviewed in a prominent, reputable journal is something else. It’s not a guarantee of anything, but it is an indication that it may be worth the effort to look at the paper.

    This article is 10 years old and was published in an obscure journal that has bounced from publisher to publisher, had a zero impact factor, and looks like it’s not publishing any longer. Of course it’s particularly inane, but there are no shortage of “peer-reviewed” papers of similar inanity from which to choose, especially from the pile of “journals” that nobody reads. Note that the second author is an professor at a department of English (red flag if there ever was one).

  9. Terry,
    Lucky for you gravity is a weak force otherwise you might have been hurt. I had to search to find the meaning of “interpellated by hegemonic discourses”.
    https://lucian.uchicago.edu/blogs/mediatheory/keywords/interpellation/

  10. Modern Medicine is awesome. Modern Medicine also suffers from the dangers of policy and procedure.

    My father had bumps on his head. They were no annoying enough to quickly go to a doctor. They were just a little annoying. As we get older we get use to some pains. These were less than those pains. Eventually they got annoying enough that he went to see a dermatologist. The dermatologist put him on some variant of drug. He took it for three months and the bumps didn’t go away. My mother had the same bumps on her head. For some reason she stumbled upon the Baking Soda/ Apple cider vinegar hair cleaning method. She tried it. Her bumps went away. She made him some bottles to do the same. His bumps went away.

    Anecdotes. Not evidence.

    Except I too had bumps of the same sort. They came and went for more than 2 years. I finally made an appointment. My mom told me about her solution. I tried it. It worked.

    1 Tablespoon Baking Soda in 1 Cup water. Scrub into hair.

    wait for a couple minutes.

    use 1 Tablespoon of Apple Cider Vinegar in 1 Cup of water to rinse the baking soda out.

    I would use it all the time, but it isn’t as convenient as head and shoulders.

    How many dermatologists will recommend this method? The most likely place you are to get this advice is from a Naturopath.

    Suddenly I am in the conundrum loop of agreeing with this article and disagreeing with it.

  11. the French’s favorite filmmaker is of course Jerry Lewis… ‘nuf said.

  12. Brad: It’s not an either/or situation. You made your chose based on evidence—it worked for your parents. If it had not worked for you, I’m guessing you would have abandoned the idea. The same is true for conventional treatment, as you note. Some treatments work for some people. I have a really great dermatologist who is used to the idea that my reactions to medications are not what most people have and he adjusts accordingly. Both he and my former ENT have recommended natural products in addition to or in place of prescription medications. There’s nothing wrong with rejecting conventional treatments that don’t work or using non-conventional treatments that work. That’s just being realistic and reasonable.

  13. With doctors leaving private practice in droves for employment in hospitals or giant medical groups we will be seeing fewer people opting to study medicine. Within a private practice a physician can earn their maximum possible by working longer hours. Many do this in an effort to pay off student debt. As they get older they end up working less but still much more than their colleagues in a corporate setting. You now see the older docs moving from private practice for quality of life. They are content with lower pay after their largest expenses (student loans, college age kids) are met. The cost/benefit ratio for new graduates may well have them deciding their time would be better spent outside of medicine.

  14. Ye Olde Statistician

    March 1, 2016 at 4:04 pm

    Wait, why did I fall?

    Obviously, it was because you laughed too hard. That is, it was a personal, human reason, not a fascist objectifying reason!

  15. YOS,

    No, that would produce levity and thus prevent falling. 😉

  16. Briggs, you didn’t mention the nursing connection. That explains everything – it is all in defence of therapeutic touch. As soon as other ways of knowing is mentioned we know what is coming next. A hoax is always a possibility but unlikely with the nursing and english connection. Ottawa and Toronto, the shame the shame.

    I’m always a little leery of claims of “evidence based medicine” since this should be taken for granted. I am suspicious that a shell game is underway or maybe a Hamlet quote is appropriate:

    “The lady doth protest too much, methinks.”

    A journal of evidence based medicine (healthcare) publishes an article criticizing the same. Have the publishers accidentally exposed the scam? This really should be a hoax.

  17. brad tittle, you’ve put the whole profession of phrenologists out of business.

  18. I get it that you don’t care for the odd science philosophy, but you know there’s plenty of it coming from all quarters, not just the social left-wing.

    JMJ

  19. acricketchirps

    March 2, 2016 at 2:13 am

    From the left when no argument can be made a little tu quoque should always be advanced. It’s better than remaining silent.

  20. We all know the importance of being earnest.
    This wooly, vague, mixed up and insincere writer has picked up some, now old, buzz words and seems to misunderstand what the phrase referred to in reality.
    Evidence is part of critical analysis.
    Some evidence is more compelling than others.

    The only reason to argue about the truth of a thing is because there’s a mystery there to start with. Otherwise it would be idiotic to argue. Medicine is not exact and there is a lot of mystery. In order that people don’t become lost altogether rules and protocols are set out sometimes. This is problematic because it leads to non thinking robotics and it’s own obvious hazards.

    Physios have a different role and level of autonomy by a country mile than in the US. It is always said that this is because of the litigious nature of the US. In the US they work under strict orders of Drs. How dull, especially when they don’t know what we do! “can I watch? how do you do what you do?” Drs have generally dumped listening to patients and physical examination for imaging alone but it’s lead many astray. There is a great placebo effect with imaging just as with almost anything from the look of the clinic to the aspirin. Placebo is everywhere. To even know you’re helping for the reason you think you’re helping is an interesting thing to think about.

    The paper is written by committee after a Chinese whisper session. He’s never been near a ward or a clinic in his life. When he does, someone should hand him a mop and remind him to concentrate on the corners.

  21. JMJ: You’re correct, but since the social left-wing is dedicated to obscuring reality, they get blamed for most of it. The social left wing also despises rules not created by them and for them, which medical rules fit that idea. I can see an argument made for homeopathic medicine because to not allow it is to discriminate against those seeking it. Probably it could be considered racist if say hispanics or blacks use alternative medicines often. It’s in line with the other ideologies of the left.

    Joy: No, the writer insists evidence is fascist and should not be the only criteria applied.
    As Scotian noted, there is a nursing connection and probably a connection to therapeutic touch. The paper was written by two persons with RN’s plus PhD’s and two English professors (thus the flowery language) all of whom write on politics and medicine. Amelie Perron is listed as the author of “On the Politics of Ignorance in Nursing and Health Care: Knowing Ignorance”. Other papers by these authors are in a similar vein. It’s not a huge leap to believe the authors are indeed pushing therapeutic touch to advance the status of nurses and this has nothing to do with patients at all.

  22. “a dominant ideology comes to exclude alternative forms of knowledge, therefore acting as a fascist structure ”

    Considering that it is Canada, I think it is simply an attempt to justify using Aboriginal medicine and healing practices: http://www.med.uottawa.ca/sim/data/Aboriginal_Medicine_e.htm

  23. “many scientists find themselves interpellated by hegemonic discourses and come to disregard all others…”

    Wow! So uttering the phrase “the science is settled” actually reveals the speaker to be an exclusionary crypto-facist. Heil Popper!

  24. Sheri: I wasn’t implying that evidence should not be used in medical decisions and I was not validating the author’s thesis. Albeit in a clumsy manner, I wanted to convey ideas more clearly expressed by Dr. Donald Miller Jr. in his article, “Modern Medicine at the Crossroads,” specifically in the section Practice Guidelines and EBM, which concludes:

    “Evidence-based medicine applies the principles of epidemiology to individual patient care, basing that care on statistical trials. Probing EBM, co-author Clifford Miller and I conclude, ‘EBM has failed in the real world of medicine, in terms of its use in making medical decisions and in proving causality. It has been successful politically. Health service managers, public health professionals, biostatisticians, health economists and politicians continue to prosper using the statistics that EBM provides, acting to rein in the purported dangers of passive smoking and low-dose radiation and to promote the claimed benefits of low fat diets, statins and influenza immunization.’ As Bruce Charlton and Andrew Miles put it, ‘EBM stands revealed as statistical rather than scientific; its success more to do with managerial dominance than medical desirability.'” (Journal of American Physicians and Surgeons) http://www.jpands.org/vol20no3/miller.pdf

    I also had in mind this quote from the 2009 New York Review of Books article by Dr. Marcia Angell, former Editor-In-Chief, New England Journal of Medicine: “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.” The article is entitled, “Drug Companies & Doctors: A Story of Corruption.”

    Thanks to the ACA, your doctor now needs to protect himself by making sure your “permanent record” includes the record of your compliance, or noncompliance, with government/political health edicts.

  25. Sheri, who knows if the writers thought they pushed they failed..
    There’s nothing like flowery writing and that was nothing like flowery writing. They were not clinicians.
    Who said that touch wasn’t therapeutic? and of course, by definition, it is to do with patients.
    This is old so it is about the time when the “awful, and it was awful, “evidence based practice” verbiage was supposed to be revolutionary,
    I mean it was like starting a new trend by saying “engine based automotive”.

  26. Jean, as I thought.

  27. Jean: Thanks for the clarification. The ACA certainly did change things—I now have to have an A1c for insurance coverage and some pharmacies require it to purchase insulin. I had refused in the past because it’s a waste of money. My diabetes is under the best control it can be, I test several times a day and it’s been that way for over 40 years. Now, I am forced to have the test. So far, a required value is not necessary, but if in the future there is, I may have to resort to black market insulin or something, since there’s no way I can make anywhere near the goal. Actually, many type 1s cannot. Yet that probably won’t keep the government from mandating it.
    Also agreed that research and physicians cannot be taken at face value. You have to back it up with your own research of several studies. Once I found a treatment in European journals that worked, but was no where to be found in the US. It was inexpensive and available over-the-counter. Without research, I’d never have known about it.

    Joy: Scotian (I think—correct me if I’m wrong, Scotian) and I are referring to a specific “therapeutic touch”—from the official site “In 1971, Dolores Krieger, R.N., Ph.D., along with Dora Kunz, a natural healer, conducted some experiments to examine the effects of healers on humans in an analytical way. They used an experimental group and a control group consisting of comparable individuals. The experimental group received “laying-on of hands” healings while the control group did not. Dr. Krieger measured hemoglobin levels in both groups both before and after a series of healing treatments. There was a significant increase in hemoglobin levels in the healer treated people. From these early experiments, Therapeutic Touch was born. Dee and Dora learned early in their experiments that you did not need to touch the person to have an effect. “
    While this is claimed to be scientific, evidence based it actually falls under the paranormal side more than anything. Especially when you don’t even need to touch the person to have an effect.

  28. Sheri, The “healing hands” concept is old, it’s biblical.
    Clinicians don’t have to touch the person to have an effect, nobody argues about that.
    As for the peculiar haemoglobin claim, well, why haemoglobin? I can’t be bothered with it.

    Many physios and GP’s in particular put more or less emphasis on strange or unexpected (not paranormal) effects and generally speaking the ones who are “black and white”, simplistic thinkers (not always males by any means, see no mystery because they’ve stopped thinking not because they are thinking any clearer. The human body is not a man made machine. It does not behave like a computer. When it does you must try not to show your surprise. Not to give my examples but I refer you to Michael Crichton’s story about the man with the curse. Use of placebo to save a life.

  29. http://www.blc.arizona.edu/courses/schaffer/182h/Climate/Fear,Complexity, & Environmental Management in the 21st Century.html
    I don’t think that link will work directly but this is the essay I referred to.
    It’s old but human anatomy and physiology hasn’t changed since it was written.

  30. Joy: Actually, scientific evidence is completely lacking for “touch without touching” having any effect whatsoever. It’s 100% illogical and impossible. One either touches or they do not. If one does not touch, then it’s “passing hands in the air over the patient”. “Healing hands” may be Biblical, but not scientific if talking about energy fields and so forth.

    Yes, use of a placebo can save a life—IF there is nothing else wrong. So can psychics, gypsies and those who speak with the dead. The point is this is not science. Unless you are counting only anecdotal evidence, in which case I can “prove” cancer is not caused by smoking by citing those who smoked and did not die, “prove” a visit from a dead relative can “cure” depression and I should start buying all the quack cures Doctor Oz promotes. That’s advocating throwing science out of medicine and returning to the gypsy medicine wagon cures. Thanks, but no thanks.

    England is more involved in this, probably because the prince is an advocate. He also advocates wind turbines, green energy and thinks we are killing the planet. Which are all “scientific” using your criteria. If one “believes”, that is enough.

  31. Sheri,
    The Point I am making and which the Michael Crichton example illustrates is that there WAS something wrong with the patient. He was dehydrated, he had signs o shock thought to be caused by adrenal affects of fear and hopelessness, due to false information only, no other cause. Intervention had made no difference.
    The cure was the correct information. It ought to be obvious that no laying on of hands took place, no physical contact, just information.

    On the matter of evidence: experience is evidence. Measurement is evidence. Observation is evidence. Palpation is evidence. Listening is evidence. Imaging is evidence. Blood results are evidence. History is evidence. conference is evidence.
    The most valuable evidence to a physio is the subjective evidence and it is the part that is most often overlooked by inexperience where by necessity thinking is linear and simplistic. It is not the only evidence.

    This is another non argument regarding where the conflict lies. It is elsewhere from where politics or financially interested groups insist it resides. The odd assertions about medical science and healthcare are misplaced. If you thought medicine was like chemistry you thought wrong. The human body is a complex system. All complex systems are difficult to manage.

  32. Joy: Subjective evidence is not science. Unless we’re discussing psychology and sociology which are marginally scientific.

    I am well aware of the complexity of the human body and the inability of even scientific medicine to accurately predict reactions to treatment. However, when we drop science, we return to the gypsy wagon, Dr. Oz, and medicine men. If one wants to use a medicine man, that’s okay with me. However, the problem is two-fold (1) There will be no way to even guess if a treatment works or can harm you—politics is creating this situation right now in scientific medicine as are personal injury lawyers, and (2) generally people want other people to pay for their choices. As previously noted, this whole thing is about insurance coverage—ie money. And the homeopathic/natural industry is a $34 billion dollar a year enterprise in the US that is unregulated. Sounds like a lot of money to me. My guess is they see billions more if insurers are forced to pay for treatment and vitamins.

  33. Sheri, You are incorrect.
    Subjective information is evidence in medical practice. You’ve mixed research and medical practice. The Michael Crichton case was not psychiatric the patient was assessed as normal. He had erratic signs of shock.
    The rules of assessment and diagnosis apply in all areas. The pejorative “ways of knowing”, sadly Sheri and Scotian, include subjective examination. One could say “methods of discovery” varies.

    Except where a patient is too unwell to communicate, examinations
    contain subjective information. Symptoms are subjective. They are evidence too!

    It’s even worse when considering interpretation of images by third parties. Physical examination of internal structures recorded as part of the objective exam are pretty subjective but are called “signs”. The assumption is that the assessor is objective and the patient’s contribution is subjective. That’s the basic framework. This is how it works.
    I’m not complaining but there it is.

  34. No, Joy, I am not incorrect. Doctors use clues to diagnose and treat, but wild guessing is not using clues and using completely unscientific ideas for diagnoses is not science. Doctors fill in blanks that medicine and science lack and they deduce from evidence what the patient has. They can, of course, deduce incorrectly. But it is not scientific for someone to go in to a doctor and the doctor to drag out tea leaves, read them and then prescribe a trip to the Wellness Mart for vitamin B. That’s what homeopathic and non-scientific methods do (minus the tea leaves—they just examine you and make a proclamation or do some questionable, non-repeatable “tests”).

    You are confusing subjective with wild guesses based on no evidence or non-repeatable methods. Subjective is a doctor using what he knows to assess and then fill in blanks he can’t get the patient or tests to fill in. This is based on his scientific training that gave him the MD behind his name and his experience. That’s why we don’t let witch doctors use the MD—it implies science and training. The witch doctor is 100% subjective. My guess, and maybe I could find studies to back it up, is that doctors make similar diagnoses based on the facts of a case versus wild guesses by non-doctors. The fact that doctors make mistakes is a problem with human beings, not science. We don’t know everything. However, lack of knowledge is not what is being discussed in the lack of science in medicine, but rather techniques and practices based on exactly what that witch doctor used—wild guesses, a bit of luck and a gullible population. These are not science and have no place in medicine. They are, however, great for natural remedies bottom lines and all kinds of internet sales of miracle cures. Remember, chance means a few times out of hundreds, these items will work, and it’s those happenings that keep the profits way up.

  35. Sheri you love “research” “scientists” now? perhaps you mean medical scientific research.
    Just as I said in my first comment on this. Evidence Based Practice or medicine is not what you think. Who could argue against the words? Only those who know what the politically motivated consequences were. When you are denied treatment, not physiotherapy treatment, because “studies show” you will know all about evidence based medicine or practice.

    When I speak of medical practice that is precisely what I speak of, not your version of what that is, not your construction of what it means.
    If you want me to read your tealeaves though I’ll have a go. My Dad’s Mum was known for it! neighbours came from all about and I look like her, apparently I have her wrists.

    Arguing the truth about How diagnostic assessment works, leave aside that it Does isn’t sensible.
    As Dr. Crichton MD would say, “work on it.”

  36. Joy: I didn’t say research scientists per se. I did not comment on the accuracy or lack of said value in medical research. Nothing of the sort.
    Again, as most people in a disagreement, you immediately ASSUME I have no familiarity with physiotherapy, homeopathic doctors, etc. Does that somehow make it easier to just dismiss what I say? Especially since you know nothing of my health, my costs for health, services I’ve used, etc. You can create any scenario in your head and use it to prove your point.

    My “version” of medical practice is precisely what medical practice is. Using unproven medical techniques such as chelation therapy, touch therapy where there is no touch, apricot pits to cure cancer, etc, is NOT medical practices. They are a medical version of alchemy.

    Michael Chrichton would have no problem whatsoever with my scientific definitions and ideas. I know the difference between science and pseudoscience. That’s what is important.

    Because you insist on creating your version of my viewpoints, I see no point to further discussion. There is “nothing to work on” because your interpretations of my viewpoint are flawed.

  37. Physiotherapist is a protected title. Such a creature doesn’t exist in the US.
    The role of the GP is to diagnose or narrow the field and treat immediately.
    If this is not possible the patient is referred, the field having been narrowed to whichever department normally off site but sometimes in house. Physiotherapy is but one option.

    Dare I bring it up, again?…Crichton’s colleague was another Dr! several staff with head dresses and rattles! a motley crew all around the bed! In hospital! In the nighttime!

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