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Anti-Psychiatry Prejudice? A response to Dr. Lieberman


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Facets of the field

Kelly Hills (@rocza) was kind enough to call my attention to the guest post on SciAmMind by Jeffrey Lieberman, incoming president of the American Psychiatric Association (APA).

 

Frankly, I’m appalled by Lieberman’s post, especially as it was invited. Although masquerading as a reasoned critique, it is anything but that. Rather, the piece is self-promotional and condescending.

Rather than respond to critics of the APA’s new Diagnostic and Statistical Manual of Mental Disorders, aka DSM-5, the Bible of psychiatry with sound arguments, Lieberman stoops to disparaging characterizations of critics as “real people who don’t want to improve mental healthcare,” and that he, as  Professor and president-elect of the APA, is in a far better position to understand and solely make decisions.

Besides that it contained no data or sound arguments to his critics, the fact that Lieberman failed to disclose his own extensive conflicts of interest is quite telling, and precisely why the field of psychiatry is getting such a bad name.

I am not anti-psychiatry. I have seen the good that can come both from medications that are used judiciously and monitored carefully, and of different “talk,” insight-based therapies.

Over my decades of internal medicine practice, I have seen a shift in psychiatry that appears largely driven by reimbursement constraints and by heavy pharmaceutical detailing. Psychiatrists—and other physicians—are not reimbursed for listening carefully to patients, a time-consuming but ultimately cost-effective technique. They are paid by volume of patients seen and procedures performed, and in the case of psychiatry, effectively for medications prescribed.

To respond more specifically to Dr. Lieberman’s  assertions:

To characterize critics as “misguided and misleading ideologues and self-promoters who are spreading scientific anarchy” is rather ironic, given that it is psychiatrists who have the financial gain through promoting their field and by periodically changing the ground rules. In fact, even the DSM manual is a cash cow for the APA, costing $199 per copy. New diagnoses and coding are also opportunities to sell ancillary products, be it billing software or coding classes, as happens in some other specialties.

Dr. Lieberman complains whiningly, “No other medical specialty is targeted by such an ‘anti’ movement.” He continues, “Being ‘against’ psychiatry strikes me as no different than being ‘against’ cardiology or orthopedics or gynecology.” 
Yes, Dr. Lieberman, psychiatry is different. These other specialties, in most cases, are far more evidence based, with more readily measured outcomes.

Lieberman then asserts, in an arrogant and offensive tone, “Like most prejudice, this one is largely based on ignorance or fear–no different than racism…many people made uncomfortable by mental illness and psychiatry, don’t recognize their feelings as prejudice. But that is what they are.”
 No. Instead, having no personal gain at stake, others are looking at psychiatry more objectively than you. We are looking for data, for evidence, and are listening to the growing numbers of patients saying that they have been harmed by medications—meds often forced on them by the medical-legal system.

As Duke University’s Dr. Allen Frances notes in the Annals of Internal Medicine, “Psychiatric diagnosis is facing a renewed crisis of confidence caused by diagnostic inflation.”
 Critics are also fueled by psychiatry’s attempts to medicalize normal human behavior, such as grief.  Such efforts fly in the face of commonsense and inspire ridicule.
 Dr. Frances concludes, “These changes will probably lead to substantial false-positive rates and unnecessary treatment. Drug companies take marketing advantage of the loose DSM definitions by promoting the misleading idea that everyday life problems are actually undiagnosed psychiatric illness caused by a chemical imbalance and requiring a solution in pill form. This results in misallocation of resources, with excessive diagnosis and treatment for essentially healthy persons (who may be harmed by it) and relative neglect of those with clear psychiatric illness (whose access to care has been sharply reduced by slashed state mental health budgets).”

Even the Director of the National Institutes of Mental Health (NIMH), Dr. Thomas Insel, has rejected the DSM, stating:
“The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.
Patients with mental disorders deserve better…NIMH will be re-orienting its research away from DSM categories.
Conflicts of Interest

Let’s look at who stands to gain by the new DSM.
 First, there is the product itself. While I never thought I would agree with anything on Fox News (yes, this reveals recognition of my own bias), Dr. Ablow, in Be Wary of the APA, said of the new criteria, “But those labels aren’t driven just by science, but by political, economic and commercial forces within the American Psychiatric Association that may have nothing to do with the wellbeing of patients – or with reality.  
The labels in the DSM-V (like the Diagnostic and Statistical Manuals that came before it) have really become little more than the roadmap by which psychiatrists chase both insurance reimbursement and applause from special interest groups who lobby—sometimes very effectively—for one diagnosis to be included, or another to be removed.”

And Dr. Frances chides, “I believe that the American Psychiatric Association (APA)’s financial conflict of interest, generated by DSM publishing profits needed to fill its budget deficit, led to premature publication of an incompletely tested and poorly edited product. The APA refused a petition for an independent scientific review of the DSM-5 that was endorsed by more than 50 mental health associations. Publishing profits trumped public interest.

 New psychiatric diagnoses are now potentially more dangerous than new psychiatric drugs, because diagnostic expansions may lead to drug company promotions that dramatically increase the use of unnecessary medications, with high cost and potentially harmful side effects.”

Dr Lieberman states that the panel recommending the new APA definitions was carefully vetted and lacked conflicts of interest. The standards for claiming financial purity are pretty low:
 the amount they could receive from drug companies was set at $10,000 a year and  stock holdings to $50,000, excluding research grants, were allowed.

Tufts and Harvard researchers found that 57 per cent of the APA work groups drafting the manual – had links to industry. 
I know. They are just prejudiced against psychiatry. Such examination is a witch hunt.

Perhaps the most egregious  statement in Lieberman’s opinion piece occurred when he referred to prior ethical lapses and barbaric treatment of patients, saying dismissively, “However, that was then and now is now.”

Yes, Dr. Lieberman, now is now, and ethical lapses are still occurring. I have spent months following up on information from Dr. Carl Elliott and writing substantive, well-documented posts, such as that on why I now call for an investigation of the UMN Department of Psychiatry, on Conflicts of Interest and the whole series on Dan Markingson’s death, still in progress.

Surely you are aware of the controversy surrounding the UMN’s Department of Psychiatry, and particularly around conduct of the CAFE and CATIE studies. After all, you were the Principal Investigator on these multi-center studies. Are you in denial as to the ethical breaches that occurred on this study?

Why didn’t you mention in your article that you were the PI on the study that Dr. Carl Elliott, I, and others, have been criticizing?  Didn’t you feel that was relevant, or that readers would know what to make of that information?

Only buried in the fine print is mention of your research on schizophrenia and anti-psychotic medications. And even the fine print doesn’t happen to mention your having received research grants from: Allon; GlaxoSmithKline; Janssen Pharmaceutica Products, L.P. (US); Merck & Co., Inc; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Sepracor Inc.; Targacept 
Served on the advisory board for: Bioline; GlaxoSmithKline; Intra-Cellular Therapies, Inc.; Eli Lilly and Company; Pierre Fabre; Psychogenics; Received patents from: Repligen Corporation

You ask why there is mistrust of psychiatry and psychiatrists? You, sir, have just answered that by your omissions and by your undocumented attacks on your critics.

Do you believe the more than 2500 signatories, including those of three former editors of the New England Journal of Medicine, a former editor of the British Medical Journal, the editor of the Lancet, and numerous scholars from all over the world, are just prejudiced against psychiatry, when they ask for an investigation of UMN’s Department of Psychiatry by Minnesota Governor Mark Dayton?

Conclusion

So many symptoms are now being medicalized, even absurdly, grief. It makes me wonder if there a DSM 5 diagnosis for someone who is self-serving, can’t accept criticism, and believes critics are prejudiced bigots?

I was very disappointed to see Dr. Lieberman’s shallow, self-serving and evidence-free diatribe appear in Scientific American as a guest opinion. He failed to reveal important conflicts of interest. He made serious claims for which he presented no evidence. He has made thinly veiled personal attacks on his critics, without offering anything substantive to counter rationally. Dr. Lieberman has failed to offer any evidence to refute assertions that Dr. Elliot and others have made, on a point by point basis.

Dr. Lieberman, instead of  publishing evidence-free attacks on your critics, I  invite you instead to respond point-by-point to Dr. Carl Elliott’s well-documented assertions regarding ethical lapses and other problems  in the CAFE and CATIE trials, on which you were the lead investigator.

Credits:

Psychiatry tag cloud – Scrag/wikipedia

“Molecules to Medicine” banner © Michele Banks

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Judy Stone About the Author: Judy Stone, MD is an infectious disease specialist, experienced in conducting clinical research. She is the author of Conducting Clinical Research, the essential guide to the topic. She survived 25 years in solo practice in rural Cumberland, Maryland, and is now broadening her horizons. She particularly loves writing about ethical issues, and tilting at windmills in her advocacy for social justice. As part of her overall desire to save the world when she grows up, she has become especially interested in neglected tropical diseases. When not slaving over hot patients, she can be found playing with photography, friends’ dogs, or in her garden. Follow on Twitter @drjudystone or on her website. Follow on Twitter @drjudystone.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. meegwich 4:36 pm 05/24/2013

    Judy, just an excellent article and rebuttal. I especially appreciated the notice of Lieberman leaving off his conflict-of-interest resume. It seems that item is taught in first semester psychiatry, and you’re graded on it your entire professional career. At least he didn’t claim that the reason he doesn’t inform his patients of his conflict-of-interest’s is that they would only become confused, that little quote belongs to Charles Schulz at the University of Minnesota. Mary Weiss, the mother of Dan Markingson, whom Carl Elliott and yourself have written extensively, accurately and truthfully about, wrote the great Jeffrey Lieberman after the death of her son while participating in his CAFE’ drug study. The response she received was the same ego driven, self-serving, non-apology, pharmaceutical induced opinion that you just took exception with.
    Thank you for restoring some sanity and reality to what otherwise was just another greed induced mumbling from a so-called psychiatric mouthpiece.

    Link to this
  2. 2. tmonk 5:07 pm 05/24/2013

    You can read my reply to his blog.It is the first, and last (I think) as Tmonk.

    I am an academic psychiatrist, who teaches neuroscience and primary care psychiatry and as I stated in my note-the terrible sadness about all of this is that so many good, smart, and caring psychiatrists who truly help to save lives, who never took drug company monies to promote questionable data, get lost in the weeds of the ideologues.

    As I mentioned in my note-it is peculiar that the APA does not, with its amply funds, delegate grant monies to teach/research pure neuroscience and that what appears to be the bulk of psychiatric neuroscience research comes from outside this country.Funding for drug company research is not hard to come by.

    TM

    Link to this
  3. 3. Discover and Recover 5:41 pm 05/24/2013

    Great article.
    You touched all the bases.

    Thank you!

    Duane

    Link to this
  4. 4. Phil Hickey 5:43 pm 05/24/2013

    Judy,

    All we can do is keep saying it.

    By the way, did you notice that in the last three paragraphs of his article, he breached the confidentiality of a colleague’s wife?

    Phil Hickey
    http://www.behaviorismandmentalhealth.com/

    Link to this
  5. 5. Judy Stone in reply to Judy Stone 6:03 pm 05/24/2013

    Good point. Thank you!

    Link to this
  6. 6. Robert D. Stolorow, PhD 7:07 pm 05/24/2013

    Deconstructing psychiatry’s DSM: http://www.psychologytoday.com/blog/feeling-relating-existing/201204/deconstructing-psychiatrys-ever-expanding-bible

    Link to this
  7. 7. softwarematters 12:52 am 05/25/2013

    Only one thing to say: I subscribe each and every single word of this article. Great job!

    Link to this
  8. 8. jenniferLreimer 2:48 am 05/25/2013

    VERY well-said. I am of a very similar opinion. I think it’s rather logical that until profit-making is separated from science and psychopharmacology, the system, as it is, simply does not allow for sound research. This “trickles down”, as the same corporations that make the pills fund the universities that teach the doctors that every man above 40 should be shooting testosterone, every woman above 50 should be on Estradiol, and everyone above 60 would be mad not to be on Lipitor.
    And people that cry, get emotional in public, even? Well, they must be quelled, we don’t want people to start to panic, here.
    If SSRIs (selective serotonin reuptake inhibitor antidepressants) were designed to relieve some PHYSICAL ailment, they would have been taken off the market in the ’90s. Why? ALL LONG-TERM EVIDENCE DEMONSTRATES THAT THEY ARE NO MORE EFFECTIVE THAN A PLACEBO. Furthermore, they have this funny effect of making teens and young adults WANT TO KILL THEMSELVES AND/OR OTHERS.
    But, because these pills treat “diseases of the mind”, it is the patient’s fault – well, their sick mind’s fault – if they do not work. Doses are raised. Atypical antipsychotics like Abilify are added. A mind-numbing cocktail is created that does not improve the quality of life for psychiatric patients like myself, it makes it bearable to face the world, functioning in a state very far from any “normal” I’ve ever known. Not that I would be the expert on “normal” ;)
    I have had psychiatrists that have been outright abusive in their treatment. One threatened to take me off all medication (a week before I was due to start grad school) if I did not switch to a mix of Thorazine and Lithium at once. I had her fired. Students still thank me. Others have prescribed drugs, as they only can – by trial and error – that either do nothing, make me feel much worse, or make me go REALLY crazy until I need a shot in the ass and some time in a hospital bed.
    Is this humane treatment for a young woman who functions very well, but happens to have Bipolar Disorder – a condition more neurological (neuronal death, hippocampus activity…), and thus physiological, no?
    I never take my morning or bedtime cocktail, that was 10 years in the making, for the one psychiatrist that did not write me off as another lost cause and actually followed my reactions to medications over a decade until the point where we could work together and find something that worked and that I was comfortable with. I wish that everyone were so lucky, but know that psychiatrists like him are rare. His methods are not always “traditional”. He takes risks that others working down the hall do not, and his patients tend to do better. He cares more about “healthcare” than “lawsuit avoidance” and “free trips to warm places”. The stationary doesn’t seem to require that one prescribe the drug whose name is emblazoned on the bottom half of a post-it.
    Lieberman is only embarrassing himself, or at least setting himself up for it. My current psychiatrist, also a good one, laughs at the DSM-V if I even bring it up. My previous psychiatrist did not know or care when it was coming out.
    Perhaps we best be wary of psychiatrists that think of the DSM-V as a “Bible”, or any book as a “Bible”. Perhaps more $199 copies, not paid for by doctors but placed in front of their office doors like phone books, will be filed under “G” than we think.
    Luckily, this is not in Lieberman’s hands – it is in the hands of psychiatrists, as well as patients, who, if able, can do what I did and not stand for inhumane treatment. I realize that I am high-functioning and patient advocacy groups need to step in as well.
    It would be very interesting to analyze Lieberman’s lofty generalizations and comments about his peers in relation to DSM-V diagnoses. If nothing else, I think he is a very obvious malignant narcissist (NPD), and that he has some serious problems with impulse control and anger.
    Thanks again for addressing this,
    Jennifer L. Reimer
    Practice of Madness

    Link to this
  9. 9. Dr Justin Marley 6:18 am 05/25/2013

    Dear Dr Stone,

    1. In your ‘About the author’ section there is a link to ‘Conducting Clinical Research’ which is described as ‘the essential guide to the topic’. Clicking through leads to a landing page with testimonials, pricing, statement about Sci Am blogging as well as click through to book purchase. Do you stand to gain financially from this? If so I might have missed the declaration of interest in this and previous posts.
    2. Doctors have a duty to raise awareness of illness. Does public education constitute a conflict of interest? Do people understand that Public Health campaigners might be being paid for their work? Should Public Health campaigns be viewed primarily as a conflict of interest? (I don’t think so) What would the impact be on heart disease, cancer and pandemics?
    3. Under what circumstances is it appropriate to generalise from specifics and where allegations have not yet been challenged?
    4. How is Delirium secondary to an infection an invalid diagnosis? Infections are common and this is a common sequel to an infection particularly in the older adult group verified by laboratory tests and neuropsychometric testing. It is important that cases of Delirium are not missed as they can have potentially significant consequences. Do you have any views on this? I have included references to back up statements on my blog article http://bit.ly/120hhYQ
    5. Are there controversial diagnostic categories or treatments in the field of infectious diseases? Whilst I understand there has been much debate in certain cases, the last thing I would dream of doing is to generalise to the entire discipline which has undoubtedly saved large numbers of lives and reduced morbidity. In every field there is iatrogenic morbidity which the profession should reasonably explain and manage.
    6. The brain gives rise to the mind and is the most complex organ in the body. It is central to almost every aspect of our lives, lives which by the decade are becoming ever more complex. The brain relates to every other system including the immune system. Is there a reason why there should be less diseases of the brain than with any other system in the body?

    I look forward to your responses

    Yours sincerely

    Dr Justin Marley
    Older Adult Psychiatrist

    Link to this
  10. 10. Dr Justin Marley 7:06 am 05/25/2013

    Dear Dr Stone,

    Just one more additional point. I read with curiosity your statements about DSM-V authors having links to industry. There is nothing wrong with having links to industry and it is the industry which contributes significantly to advances in any field. Having noted all of this, on your website conductingclinicalresearch.com/ you are careful to explain how reading your book will help readers
    ‘Attract drug companies to your site’

    Am I missing something here?

    Regards

    Dr Justin Marley

    Link to this
  11. 11. Chryses 8:23 am 05/25/2013

    “While I never thought I would agree with anything on Fox News (yes, this reveals recognition of my own bias)”

    Not to worry. Different people have different political POVs. Some hold on to theirs more tightly than do others.

    Link to this
  12. 12. BookSpine 10:40 am 05/25/2013

    Dear Dr Marley,

    “Am I missing something here?”

    No, I followed the path you described, and all I s you’ve posted. The facts show you’re correct.

    Link to this
  13. 13. BookSpine 10:43 am 05/25/2013

    Sorry, “all is as you’ve posted”, not “all I s you’ve posted”.

    Link to this
  14. 14. abbabubba 5:01 pm 05/25/2013

    An infectious disease specialist gets to respond to APA?

    Link to this
  15. 15. Judy Stone in reply to Judy Stone 6:36 pm 05/25/2013

    If you knew anything about the background, you would see that I write a great deal about clinical research and ethics, and have done a series about a psychiatric clinical trial at UMN. Therefore yes, I am perfectly capable of calling out the APA.

    Link to this
  16. 16. Judy Stone in reply to Judy Stone 6:41 pm 05/25/2013

    Dr. Marley
    Here is my long-awaited response to your comments, point by laborious point. It took me a while to understand some of your concerns, as well:

    #1) Your point that I am an author is rather specious. Is there an author anywhere who doesn’t stand to gain some way from publication of his/her work? I’m sure your own blog, “The Amazing World of Psychiatry” – “a celebration of psychiatry and the benefits it brings to people” brings you a certain attention and opportunities that you might not otherwise have.
    While you can click through, if you click long enough, to a book purchase page, you clearly missed that I also offer readers a prominent link to a free download of my text.

    And the reason that Dr. Lieberman’s non-disclosure of his conflicts of interest was so troubling is that he is bashing his critics—and criticism of the very same schizophrenia and anti-psychotics trials that he was the lead investigator on—without revealing that important and relevant detail.

    2) “Doctors have a duty to raise awareness of illness.” Yes, and they also have a duty to explain the risks, benefits, and alternatives to patients and to offer their patients a choice of treatments. I often do that with antibiotics—sort of a “pick your poison” or the side effect risk profile that you are most comfortable with.
    The education is only a conflict of interest if you have a hidden agenda or don’t offer the options (as happened with the threat of involuntary commitment to Dan Markingson if he didn’t follow Dr. Olson’s recommendations).

    I think it is generally understood that public health personnel are salaried, just like any other job. Are there many people who are not aware of this? The distinction is that public health personnel do not stand to benefit from recommendations they make or actions they take, as opposed, for example, to academics consulting with industry.

    3) See any good text on the scientific method.

    4) I’ve never considered delirium an invalid diagnosis. I’m not sure where you are drawing that conclusion from. Delirium is fairly common in febrile patients, especially if elderly. And it has a broad differential diagnosis. One of the most commonly overlooked causes, though, in patients I see, are quinolone antibiotics.

    5) Of course there are controversies in every field. In ID, the most contentious are probably “chronic Lyme,” which has not been supported by any sound data, and is often mistreated by unethical practitioners, and “chronic fatigue syndrome.”

    A difference between ID or other medical disciplines and psychiatry, however, is that psychiatry has far fewer objective and reproducible tests and measures of outcomes available to those other disciplines.

    6) There are many diseases of the brain and the mind—some structural, some biochemical, and some from social/environmental factors. I’m not sure what you are driving at.

    7) Your additional point: There may be nothing wrong with having links to industry. It is the failure to inform others of those links, especially when relevant to the immediate topic at hand, which is more likely to be problematic. (It did appear that the harsh rhetoric of Dr. Lieberman’s post was, at least in part, a reaction to the criticism that the CAFÉ and CATIE studies have been receiving on Scientific American and elsewhere—studies on which he served as the Principal Investigator.) That is what makes the COI and non-disclosure relevant.

    Two additional points of my own:
    1) I reiterate that I am not anti-psychiatry per se and, as I said in my column, I have seen good come from careful and judicious use of medications and therapy.

    2) Nor do I object to all industry ties. Yes, I conducted clinical trials for pharma. If you were to actually read my book, you would see extensive discussion of how to do so ethically, including structuring contracts to avoid things like bonuses for patient recruitment, or payment schedules (as occurred on the UMN trial I criticize) that penalize investigators for dropping patients or preclude dropping patients who are experiencing adverse side effects. I aimed for fee for services, no matter the outcome, with no vested interest in continuing a patient on a trial.

    I also never undertook a trial if I would not have been a willing participant or been willing to give the investigational drug to a family member. That was a good threshold to have.

    Finally, yes, I am more cynical about pharma and many industry practice now than I was 20-30 years ago. Most of us learn from experience.

    Link to this
  17. 17. softwarematters 6:45 pm 05/25/2013

    Judy Stone,

    Bravo!!!

    Link to this
  18. 18. barth 9:05 pm 05/25/2013

    @Dr. Justin Marley

    Whenever I encounter an utterly absurd attempt to discredit someone, I’m forced to ponder: Does this person really not grasp how ludicrous what he’s saying is? OR does he fully realize it, but he’s so desperate to cast aspersions that undermine his opponent’s position that he’s willing to put all morality aside as he fervently hopes at least some dull-witted readers will miss the absurdity and embrace his position?

    Two of your points to Dr. Stone raise questions about her integrity: not only do you suggest she’s guilty of undisclosed conflicts of interest but by then railing against Dr. Lieberman’s undisclosed conflicts of interest she’s displaying clear hypocrisy.

    Dr. Marley, do you even comprehend what a “conflict of interest” is, as opposed to a mere “interest”. Dr. Stone has an INTEREST in selling her book (though she also is now making it freely available online—thank you Dr. Stone, I just downloaded a copy and look forward to reading it–even though I don’t occupationally fall into any of the categories your book is intended for, I’m profoundly interested in clinical research practices). But Dr. Stone’s INTEREST would only become a CONFLICT OF INTEREST if, for example, she devoted a blog post to disparaging rival publications on the same subject. But even if she did so, it wouldn’t be an UNDISCLOSED conflict of interest because right beneath every blog post of hers, in the About the Author section, it says, in the SECOND sentence, “She is the author of Conducting Clinical Research, the essential guide to the topic.” Therefore, even if she had spent five separate blog posts assailing five rival textbooks on clinical research, she would not have committed the slightest breach of the canon of ethics, since there would have been no UNDISCLOSED conflict of interest. Of course, Dr. Stone hasn’t written a disparaging word about any rival texts, or said anything else in any of her blog posts that could be considered a conflict of interest because of her textbook, but even if she had, it would be irrelevant because she fully and openly revealed the textbook’s existence, and, importantly, even without clicking on anything, the wording made it clear that the textbook was available for purchase, thereby satisfying the most rigorous disclosure requirements—not that there were any in this case because there were no potential conflicts.

    I wonder if you fully understand this last point Dr. Marley—your repeated insinuations about Dr. Stone and her textbook suggest you do not. A disclosure of an interest is only required if there’s a potential CONFLICT of interest. So, for example, if a researcher is publishing a study on a new drug and he owns the patent on the drug, there’s a clear requirement to disclose. But if the researcher also owns a bowling alley, do you think he needs to disclose that? Well, in the context of her blogging, Dr. Stone’s textbook is a bowling alley—totally irrelevant. AND YET SHE DISCLOSED IT ANYWAY!!!!!!!!

    Now, Dr. Marley, you may understand why I wrote what I did in my opening paragraph. Your insinuations of unethical behavior against Dr. Stone were SO EXTRAORDINARILY ABSURD, that, on the one hand, I can’t believe you don’t realize that yourself, and on the other hand, if you do realize how meritless your case against her is, and how unlikely it is that you would persuade even the most credulous and foolish reader, and yet you unleashed your preposterous assault against her anyway……My God, Dr. Marley, what are you?

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  19. 19. Judy Stone in reply to Judy Stone 10:03 pm 05/25/2013

    Wow, @barth! Thank you for your vigorous support. Nice to “meet” you…I hope you enjoy the book and look forward to your feedback.

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  20. 20. NewGatsby 7:30 am 05/26/2013

    @Judy Stone

    “A difference between ID or other medical disciplines and psychiatry, however, is that psychiatry has far fewer objective and reproducible tests and measures of outcomes available to those other disciplines.”

    “I reiterate that I am not anti-psychiatry per se and, as I said in my column, I have seen good come from careful and judicious use of medications and therapy.”

    Then is it fair to interpret from the quoted text of your post that you see the difference as one of degree, rather than kind?

    Link to this
  21. 21. meegwich 7:39 am 05/26/2013

    Dr. Marley@ …

    A little “googling” revealed that you’ve made it your life’s work to ‘critique’ as you refer to it, anything and everything related to psychiatry and internet blogs. Consequently, I’m sure that’s the ‘personality’ disorder at play.

    Between Dr. Stone’s response and “barth’s” I’m quite sure there is absolutely nothing anyone could add except I think it’s time to put your laptop away. The U.K. is behind the U.S. in attempting to make pharmaceutical bribes and payments to physicians more transparent. As soon as the U.K. publishes actual payments to individual doctors, I’ll be verifying your financial disclosures.

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  22. 22. Dr Justin Marley 9:45 am 05/26/2013

    Dear Dr Stone

    Thank you for taking the time to respond to each of the points raised. I will respond to each in turn

    1. The declaration of interest would be merely to draw attention to the potential for financial gain. This is relevant to the subject material as you are writing about research conduct and calling into question the research conducted in specific studies. Within the biography in the text of your article your work is referred to as an ‘essential guide to this topic’. The description links to the website where as you say, you have generously given the book away as a PDF although the buy option is highlighted. The potential for financial gain still remains and is directly relevant to the posts particularly as you have utilised your Sci Am authorship within the linked page which can therefore be seen to lend itself to your authority. This was my reasoning in drawing attention to the declaration of interest issue.

    2. I could not comment on the specifics of the case you mention. My concern is really with the importance of Public Health and specifically the statement

    ‘it is psychiatrists who have the financial gain through promoting their field’

    In my opinion this statement is rather concerning as if readers assume this statement implies financial gains as a primary driver for health promotion then they would call into question the motives of psychiatrists educating the public about public health issues. To take an analogy with your own speciality – would you make the same comments about the CDC during a pandemic?

    3. As per point 2.

    4. In your article you have quoted the following

    ‘DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure’

    I wished to draw attention to Delirium which is based on laboratory tests and neuropsychometric testing and in the case of infectious diseases as a causative agent we rely on infectious disease specialists to determine optimum treatment programs to enable rapid recovery for patients. I would argue therefore that the statement above is inaccurate.

    5. You state that Psychiatry has fewer objective outcome measures. In addition to Delirium there are organic conditions which rely on confirmation of organic causes of conditions. These causes rely on laboratory tests and other forms of investigation to identify the primary cause. In addition to this where an organic cause is not identified we have psychometric evaluation tools. These are objective instruments measured by the yardsticks of reliability and validity. Is it possible that in Psychiatry there are more objective measures than in the field of infectious diseases? (e.g every infectious disease can be the cause of one or more psychiatric illnesses).

    6. The size of DSM-5 may simply be a reflection of the complexity of the brain compounded by the complexity of society.

    7. I cannot comment on the specifics of individual cases.
    I agree that informing others of links with industry is important.

    Thank you once again for your time

    Regards

    Dr Justin Marley

    Link to this
  23. 23. Judy Stone in reply to Judy Stone 9:55 am 05/26/2013

    I’m not sure I entirely understand…I think degree is more apt. It is (or can be) a medical discipline, but a big problem is the lack of reproducible tests, diagnostics, and treatments.

    Link to this
  24. 24. Dr Justin Marley 9:57 am 05/26/2013

    Dear Barth

    Thank you for your response. I will respond to your points in turn.

    1. I have not mentioned hypocrisy in my response and nor would I.

    2. I have not questioned integrity. Raising points about declaration is a matter of judgement. In my response I requested further clarification.

    3. My question was whether it was necessary to state it explicitly separately from the inclusion in the biography. Thank you for clarifying the point with your detailed response.

    4. ‘Dr Marley, what are you?’
    Please clarify the scope of your question – do you mean animal, mineral or vegetable.

    Yours sincerely

    Dr Justin Marley

    Link to this
  25. 25. Dr Justin Marley 10:18 am 05/26/2013

    p.s Dear Barth

    It can be unhelpful to make assumptions about the readership of the blog

    Regards

    Dr Justin Marley

    Link to this
  26. 26. Dr Justin Marley 10:44 am 05/26/2013

    Dear Meegwich,

    I am disappointed that you have taken a discussion based on the facts and turned it into a personal attack.

    The purpose of my reviews of blogs is to draw attention to valuable resources and reading some of my thoughts on this on the blog would reveal the benefits of harnessing collective intelligence.

    What inferences should we draw about your point about ‘personality disorder’ based on a simple search of google of someone you have not met. There are a number of inferences I would draw about this. For such a statement to be made in the context of a discussion about people with serious mental illness and how mental illness is represented in wider society I find disturbing.

    As for any relationship to the pharmaceutical industry you will find a statement on my blog. Again I find it disturbing that you are focusing on personal issues instead of the factual discussion of the serious issues in the article and in the thread.

    Such a focus on personal issues can be intimidating to those wishing to focus on some of the most vulnerable people in society around the world.

    Dr Justin Marley

    Link to this
  27. 27. NewGatsby 2:18 pm 05/26/2013

    @22. Judy Stone

    “I’m not sure I entirely understand…I think degree is more apt. “

    Some of the more entertaining posters have taken the position that Psychiatry is a pseudo-science, on the order of Astrology. I sought the opinion of someone who has some degree of familiarity with the subject material.

    Link to this
  28. 28. softwarematters 5:51 pm 05/26/2013

    NewGatsby

    “Some of the more entertaining posters have taken the position that Psychiatry is a pseudo-science, on the order of Astrology.”

    I haven’t made the point here, but I have made the point elsewhere. And yes, psychiatry is a pseudo-science on the order of astrology. This is my reasoning:

    - Now the who’s who in psychiatry -Insel, Kupfer- agree that DSM diagnosis doesn’t have scientific validity. Ie, that a “scientific cause” has not been identified for any of the DSM disorders. The same is true with astrology and their solar signs.

    - Even though there is disagreement as to whether DSM has reliability (with Insel/Kupfer saying it does and Frances saying that DSM-5 doesn’t while DSM-IV does), there is no question that the reliability of, at least DSM-5, is the same as astrology when it comes to matching psychiatry’s invented diagnosis with actual people (check this http://www.nature.com/nature/journal/v318/n6045/abs/318419a0.html ).

    - Just as astrology, the type of predictions that psychiatry makes are based on unquantifiable “human behavior” which make both endeavors very difficult to pass the “falsifiable test” that true science require (see the work by Karl Popper).

    So even if psychiatry might not be 100% like astrology, its lack of scientific validity, lack of reliability and lack of falsifiability makes it closer to astrology than to genuine scientific medicine such as oncology.

    I don’t think that these points can be argued with after what has happened this month. The disagreement among the top dogs in psychiatry is about the degree in which these now admitted features of psychiatry invalidate it as a scientific discipline or whether its promises of “biomarkers are around the corner” means that it should be given a second chance. The problem is that psychiatry has already been given many second chances in its 200 years history, only to develop scam after scam.

    With respect to the practitioners of psychiatry having an MD degree, is about as irrelevant as if they had a doctorate in classics, mathematics or no degree at all. Many of the practitioners of homeopathy -a discipline that I think is a better analogy for psychiatry than astrology- have also an MD degree, their profession/treatments are regulated -at least in the US- but there is no official recognition of what they do as “scientific”. Homeopathy is recognized as the pseudo science it is and the same should happen to psychiatry.

    Link to this
  29. 29. ssenerch 6:26 am 05/27/2013

    Excellent. You tell ‘em, @softwarematters. Psychiatry has been masquerading as a legitimate medical specialty since its inception and fooling everyone in the process. The psychiatrists who think they are doing actual medicine, who talk about invisible, so-far imagined “brain diseases” as if they were evidenced facts, are simply laughable. Whom are you kidding? Your “diagnoses” and “diseases” are no more than labels assigned to groups of feelings and behaviors and voted into existence by committee, often on political and cultural grounds. You have not observed any of these so-called “diseases” in the body; you imagine and assume they are there. That’s scientific? You may as well tell people they are consumed by evil spirits, since you have just as much evidence of that.

    That un-evidenced biopsychiatry is not already the laughingstock that it deserves to be is beyond my comprehension. It cloaks its foolishness in medical and scientific terminology impressive enough that we are all taken in and take it on faith. But there is nothing, no substance behind the terminology – there is no “there” there, there’s nothing that can shore up the DSM or the whole pseudomedical enterprise, since it all rests on a bunch of outdated, inaccurate assumptions that were never valid (validated) in the first place. House of cards that it is, the embarrassment that is biomedical psychiatry needs to come crashing down and be replaced by a far more accurate [and humane] system, and its many victims deserve reparations for the trampling of their human rights and dignity, the theft of years and much quality of their lives, the psychological and cognitive abuse (passing off your pseudoscience as legitimate medicine, and insisting it is so even in the face of obvious lack of evidence, and to the many of us who know better, is indeed cognitive abuse), and the neglect of their real needs as sufferers of emotional distress, that this completely fantastical and illegitimately powerful profession has engendered.

    The medical specialty of psychiatry was dreamt up by some 19th century asylum physicians and beefed up by 20th century eugenicists. I hope that not too far into the 21st century it will have run its course and will go the way of other failed medical experiments – into the dustbins of history. That time can come none too soon for those of us who’ve come to understand emotional distress in a much more realistic, accurate, *human* way, not through the contrived lens of symptoms and illness, but through the lens that humans are beings with complex social and emotional [and etc.] needs, who react to our environments and life events in emotional and understandable ways, and that extreme environments and events often engender extreme reactions. This should be the ‘meat’ of your profession, rather than the hocus-pocus outdated medical hypothesis from the 19th century which should have stayed there, along with blood-letting, etc.

    Link to this
  30. 30. NewGatsby 6:57 am 05/27/2013

    @28. softwarematters

    “psychiatry is a pseudo-science on the order of astrology.”

    “The lady doth protest too much, methinks.” (Shakespeare; Hamlet, Act III, scene II)
    http://answers.yahoo.com/question/index?qid=20070410132804AAIRI9H

    Entertainment indeed! :)

    Link to this
  31. 31. Chryses 10:08 am 05/27/2013

    softwarematters (28),

    I think it fair to take as given the commonly accepted idea that Medicine is the applied science or practice of the diagnosis, treatment, and prevention of disease. If you cannot bring yourself to do so, then I’m comfortable dismissing your POV as irrelevant.

    I suggest to you that an internal state of mind that predisposes an individual to find, in the absence of external or independent justification, suicide an attractive activity may reasonably be described as a disease condition.

    I also suggest to you that Psychiatry routinely successfully treats such conditions.

    If you follow the above sequence, I think you’ll see it is reasonable to conclude that Psychiatry is Medicine – at least among those who employ these terms as they are commonly used and who think rationally.

    “With respect to the practitioners of psychiatry having an MD degree, is about as irrelevant as if they had a doctorate in classics, mathematics or no degree at all.”

    That is nonsense. Those who pursue a specialization within a discipline, for example infectious disease specialists within the broader category of communicable diseases, have and employ technical terminology – jargon, if you will – which describe the phenomena of particular interest to the specialists.

    Link to this
  32. 32. SugarTax 11:58 am 05/27/2013

    @29. ssenerch

    “Psychiatry has been masquerading as a legitimate medical specialty since its inception and fooling everyone in the process.”

    Psychiatry has successfully treated many people who would otherwise have likely (high probability) killed themselves. Do you think it would be more prudent to wait for “more objective” measurements? Depending upon how much you value human life, you might agree that an intervention preventing suicide is Preventive Medicine at its best. It is much more difficult to raise the dead than it is to prevent a suicide – even though the objective measurements about being dead are more compelling than the preceding diagnosis of the mental state of the living patient. No fooling.

    “Your “diagnoses” and “diseases” are no more than labels assigned to groups of feelings and behaviors”

    Correct. Those diagnoses are evaluations of behaviors which are sufficiently far removed from the norm as to compromise the individual’s ability to (continue) to function as the individual had in the past, or may want to in the future.

    “That un-evidenced biopsychiatry is not already the laughingstock that it deserves to be is beyond my comprehension.”

    Granted.

    “But there is nothing, no substance behind the terminology – there is no “there” there”

    You are mistaken. Many behaviors referred to a psychiatrist due to the problems they cause the patient are determined to have a biological cause.

    “its many victims deserve reparations for the trampling of their human rights and dignity, the theft of years and much quality of their lives”

    The patients who have more or less narrowly been redirected from suicide seldom complain of “lost years.” As those who have committed suicide due to their aberrant mental condition(s) are unavailable to corroborate your speculation, I suggest that you’re projecting your opinion onto them.

    “passing off your pseudoscience as legitimate medicine, and insisting it is so even in the face of obvious lack of evidence”

    You are mistaken. Ref Chryses (31), above.

    “neglect of their real needs”

    A successful suicide really needs Life. How do you propose to provide that?

    That humans are self-referential sentients, each with unique, complex, social and emotional expectations, who react to what they perceive to be important events in understandable and predictable ways is the essence of Psychiatry. When the internal (mental) states precipitate external behaviors (symptoms) that render the individual dysfunctional (diseased) the psychiatrist works with the patient to enable the patient to return to a condition the patient considers satisfactory.

    Link to this
  33. 33. softwarematters 2:26 pm 05/27/2013

    ssenerch-29,

    Agreed. Beautifully put.

    Chryses-31,

    “I think it fair to take as given the commonly accepted idea that Medicine is the applied science or practice of the diagnosis, treatment, and prevention of disease.”

    Agreed, but then you pull off a non sequitur,

    “I suggest to you that an internal state of mind that predisposes an individual to find, in the absence of external or independent justification, suicide an attractive activity may reasonably be described as a disease condition.”

    Actually it is not. A “disease” in the sense of classic medicine is something that has a clear biological cause such as the type of behavior caused by late stages of syphilis, the behavior caused by late stages of Alzheimer’s or the behavior caused by true genetic disorders such as Down syndrome. What you describe, is simple a value judgement that cannot be described as “disease” except as a metaphor. This point was already made 50+ years ago by Thomas Szasz http://www.columbia.edu/cu/psychology/terrace/w1001/readings/szasz.pdf . Recently, even Allen Frances is on record admitting that the DSM definitions are not diseases but social constructs that exist in a cultural context that are relevant at the time they are written. If there was going to be an explicit admission that psychiatry is a parallel system of social control, this is it (minute 41:20 and after; it’s from a hangout organized by Science magazine this week on the matter),

    http://www.youtube.com/watch?v=Gkibj2cDeUs

    “I also suggest to you that Psychiatry routinely successfully treats such conditions.”

    Again, where is the evidence to support that outrageous statement? Because the scientific evidence tells the following,

    - Psychiatric drugs are no more effective than placebos. The most widely studied, and used, class of psychiatric drugs, antidepressants, have been shown to be basically active placebos (EH Turner, Irving Kirsch, 2008).

    - Antidepressants have been reliably linked to increasing the risk of suicide in children, adolescents, and young adults, so much so, that the FDA forces manufacturers of antidepressants to advertise the risk http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 .

    - The CDC data made public this week showed that during the timeframe 1999-2009, the suicide rate increased by 28%. This timeframe is coincident with an a time when more Americans have been taking psychiatry drugs than ever.

    Considering these facts, the conclusion is that psychiatry does more harm than good. And we can even affirm that a fraction of those 30000 suicides that happen every year in America are caused by antidepressants (and thus by psychiatry). The above studies show though that psychiatry’s interventions are no better than placebos. You do the math.

    “If you follow the above sequence, I think you’ll see it is reasonable to conclude that Psychiatry is Medicine – at least among those who employ these terms as they are commonly used and who think rationally.”

    Again, non sequitur. Your reasoning falls apart the moment you equate a broken bone to a broken mind. The analogy of a broken bone is brain damage that results from say a shot in the head. A “broken mind” is a metaphor. Everything else you say fails because it is based on a false analogy.

    “That is nonsense. Those who pursue a specialization within a discipline, for example infectious disease specialists within the broader category of communicable diseases, have and employ technical terminology – jargon, if you will – which describe the phenomena of particular interest to the specialists.”

    Again, about as irrelevant to pathologizing behavior you don’t like which doesn’t have biological causes. In the past, those pathologizing behavior held theological degrees and labelled their victims as “heretic”. What psychiatrists do in the name of DSM-5 is not different from what the Inquisition did in the name of the Bible.

    SugarTax-32

    At the risk of sounding repetitive,

    “Psychiatry has successfully treated many people who would otherwise have likely (high probability) killed themselves.”

    The data shows the opposite, that an increase in the usage of psychiatric drugs is positively correlated with an increase in suicide, which is consistent with what the clinical trials data say about the matter. So the opposite is true, right now, psychiatry kills people.

    There rest of your intervention is nonsense that has been rebutted many times over, by no other than Insel.

    Link to this
  34. 34. meegwich 4:19 pm 05/27/2013

    Pharmacies in the United States filled about 260 million prescriptions for antidepressants in 2012. But these drugs don’t work in many people and, even if they do, take weeks to kick in. Antipsychotics, for which roughly 65 million prescriptions were filled in 2012, often do nothing for the most serious symptoms of schizophrenia. On top of that, many of these medicines have side effects so objectionable that people stop taking them.
    Despite a dire need for better treatments — one in four Americans now suffers from a diagnosable mental illness in any given year, thanks in large part to the pharmaceutical funded DSM and research psychiatrist that have prostituted themselves for their masters. I’m always amazed with the fact that nobody knows how the brain really works, but just about every egotistical psychiatrist will tell how to fix it. Again folks; Dr. Stone had every right to throw Lieberman’s promo under the bus, and she did a great job.

    Link to this
  35. 35. SugarTax 7:44 pm 05/27/2013

    @33. softwarematters

    “… “Psychiatry has successfully treated many people who would otherwise have likely (high probability) killed themselves.”

    The data shows the opposite …”

    You remain mistaken. The data shows that the anti-depressants lower the probability of suicide. These medications are commonly prescribed by psychiatrists. Fortunately for you and me, my spouse is a medical librarian, and was kind enough to do a search in PubMed on the literature. I asked for the top 200 of the 1,567 returned.

    ………………

    This message contains search results from the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM). Do not reply directly to this message
    Sender’s message: Dearsweet, Here are the first 200 of the results. Love, xxxxxxx
    Sent on: Mon May 27 18:06:45 2013
    Search: ((“Suicide”[Mesh:noexp] OR attempted suicide [mh]) AND drug therapy [sh]) NOT (youth [tiab] OR child* [tw] OR adolescen* [tw]) Filters: English

    ………………

    Clin Schizophr Relat Psychoses. 2013 Jan;6(4):177-85. doi: 10.3371/CSRP.HIFR.01062013.
    Clozapine: key discussion points for prescribers.
    Hill M, Freudenreich O.
    MGH Schizophrenia Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. michelehill1@gmail.com
    Abstract
    Clozapine is the most effective antipsychotic medication for treatment-refractory schizophrenia and is also approved for suicidality in schizophrenia patients …

    ………………

    J Psychosoc Nurs Ment Health Serv. 2013 Jan;51(1):11-4.
    Ketamine for the treatment of depression.
    Howland RH.
    University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. HowlandRH@upmc.edu
    Abstract
    … Ketamine is being intensively investigated as an antidepressant therapy. To date, five short-term controlled studies and other open-label studies in patients with unipolar or bipolar depression have demonstrated that intravenous ketamine is safe and has a rapid and profound short-term effect on depressive symptoms, including suicidal thoughts, even among patients considered treatment-resistant to standard medications or electroconvulsive therapy.

    ………………

    I could go on with the refutation-by-peer-reviewed-data, but you get the picture, and if I continued, you might become depressed. Feel free to ask either Dr. Stone or Dr. Marley to verify the source of my data. One or the other should be able to access PubMed, even if you cannot.

    Incidentally, The Scicurious Brain published an article here at SciAm on May 27th on Ketamine
    ( http://blogs.scientificamerican.com/scicurious-brain/2013/05/27/fighting-depression-with-special-k/ ), and comment #1 ends with “For now, though, ketamine is saving lives and relieving immense suffering.”

    One of the benefits of having access to the data, is that it substantiates the claim that Psychiatry has successfully treated many people who would otherwise have likely (high probability) killed themselves.

    The data fails to support your claim.
    You remain mistaken.

    Link to this
  36. 36. NewGatsby 8:35 pm 05/27/2013

    @33. softwarematters

    As it comes down to an argument between you: “psychiatry is a pseudo-science on the order of astrology”, or Dr. Stone: “I have seen the good that can come both from medications that are used judiciously and monitored carefully, and of different “talk,” insight-based therapies”, then obviously I’ll listen to someone who is familiar with the subject material. SugarTax has shown what the data actually looks like.

    Verrrrrrrrrry entertaining! :)

    Link to this
  37. 37. Chryses 9:10 pm 05/27/2013

    softwarematters (33),

    “… Actually it is not …”

    Actually, yes, an internal state of mind that predisposes an individual to find, in the absence of external or independent justification, suicide an attractive activity may reasonably be described as a disease condition.

    I refer you to the Oxford dictionary, a convenient reference many people find valuable.

    “Definition of disease (noun). A disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury”
    http://oxforddictionaries.com/us/definition/american_english/disease

    You’re not using English to communicate. You’re using it to hide the fact that you’re wrong.

    Further, the observation that such a state of mind may reasonably be described as a disease condition is not a non sequitur. As noted above it is merely a fact, a data point. It neither precedes, is not concurrent with, nor follows the fact Medicine is the applied science or practice of the diagnosis, treatment, and prevention of disease.

    Your logic is also faulty.

    Link to this
  38. 38. SugarTax 9:43 pm 05/27/2013

    @33. softwarematters

    “ “Psychiatry routinely successfully treats such conditions.”
    Again, where is the evidence to support that outrageous statement?”

    While you are very passionate about this topic, I think for the reasons and data I’ve provided you remain mistaken. Take a look at the PubMed search results. Run the Medline search strategy I’ve provided. Follow the link to the The Scicurious Brain. They contradict your position. Read. You remain mistaken, but you don’t HAVE to remain mistaken.

    Link to this
  39. 39. softwarematters 12:04 am 05/28/2013

    SugarTax – 35 – 38

    Unfortunately for you, there were two meta studies by EH Turner (http://www.nejm.org/doi/full/10.1056/NEJMsa065779 “Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy”) and Irving Kirsch (http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045 “Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration”) both published in 2008 at the New England Journal of Medicine and PLOS medicine that analyzed ALL data submitted to the FDA to gain approval of antidepressant medications, including UNPUBLISHED data, that concluded,

    1- A severe publication bias in the sense that positive outcomes were more likely to be published than negative outcomes. Both studies agreed on this.

    2- A very limited advantage of antidepressant medication over placebo when the data of all trials is combined using the Hamilton Rating Scale for Depression (HRSD). There was complete agreement even in the quantitative finding. The only disagreement was that while EH Turner found this small advantage relevant, Kirsch found it irrelevant and more likely caused by an “active placebo” effect.

    Those are the facts that refute your individual, selectively biased, studies.

    Ketamine is the latest psychiatric fad of which similar wonderful claims are made as they were made back in the day of SSRIs until they were found to be ineffective and suicide causing.

    “One of the benefits of having access to the data, is that it substantiates the claim that Psychiatry has successfully treated many people who would otherwise have likely (high probability) killed themselves.”

    Actually, one of the benefits of accessing ALL DATA submitted to the FDA, not only selectively published data, is that it refutes this ridiculous statement of yours,

    “The data fails to support your claim.
    You remain mistaken.”

    The data supports my claim that antidepressants that act on serotonin are no better than placebos. This is beyond dispute now. Just as the data supports my contention that between 1999 and 2009, antidepressants were more subscribed than ever in US history and its usage has been correlated with a 28% increase in the suicide rate.

    Chryses – 37, what is this semantics now? I refer to the statement by the Clinical Psychiatry Network, http://www.madinamerica.com/2013/05/dsm-5-statement-by-the-critical-psychiatry-network/

    “the paper points out that since its origins in the early part of the nineteenth century, psychiatry has faced a fundamental question that remains unanswered: can a medicine of the mind work with the same epistemology as a medicine of the tissues. In recent decades, there has been a concerted effort to ignore this question and psychiatry has approached the ‘mind’ as if it was simply another organ of the body”

    A semantic trick is not going to settle this issue. You just showed that you are prone to sophistry, nothing more. Your argument remains a complete false argument because it is based on a false assumption, namely, that a “broken mind” is the same as a “broken bone”.

    Link to this
  40. 40. softwarematters 12:17 am 05/28/2013

    SugarTax – 35 – 38

    And to clarify. When I say ALL data this means that the data was obtained directly from the FDA using FOIA (Freedom of Information Act) requests by both researchers. The drug companies are required to submit this information to the FDA in order to gain approval for their drugs. These companies ARE NOT required to publish it in the peer review literature. So, just in case you were about to suggest it, I am not claiming conspiracy or anything along that sort. I am saying that playing with existing rules, it is perfectly possible to find individual studies in the peer reviewed literature that show efficacy while if ALL the data is analyzed together the result is that there is no efficacy.

    The reason for this sad state of affairs is that the FDA has a lower standard for approval of psychiatric drugs than for other drugs. Companies are required to submit ONLY two studies showing a positive effect regardless of how many of those studies are carried out. While the drug companies have an obligation to submit the data of all the studies to the FDA, they are not required to make it public. And in fact, they did not make it public. It was only made public through the FOIA requests.

    Link to this
  41. 41. CurrentOutlook 5:26 am 05/28/2013

    SugarTax,

    This has started to become a tad technical. What is “PubMed”, and why is it important here?

    Link to this
  42. 42. SugarTax 6:58 am 05/28/2013

    CurrentOutlook,

    When someone says “the data shows” that neither the medications nor the talk/insight based therapies of Psychiatry are any better than Astrology, you can look and see what the facts are.

    My spouse does PubMed searches for Doctors and postdocs every week, so I took advantage of that opportunity to get the facts. When a company wants to sell a new drug to “cure ‘X’”, they need to provide the FDA with a study showing that the product does what the company claims it can do for the patients it is targeted for. The FDA will also pull the drug from the market even if it is effective, if subsequent research shows the negative side effects outweigh the benefits, as meegwich alluded to.

    These studies are routinely recorded in MEDLINE (Medical Literature Analysis and Retrieval System Online), which is a bibliographic database of life sciences, biomedical information, medicine and health care in general. It includes peer-reviewed and criticized articles from academic journals. It doesn’t have the most current abstracts available, because, I’m told, it takes 1 to 6 months to index their “MeSH terms”.

    PubMed (finally!) is an access system / front end to (primarily) MEDLINE. PubMed is maintained by the National Library of Medicine, which also maintains MEDLINE. Anyway, this is one of the mother loads of peer-reviewed biomedical publications. So when a doctor, nurse, or researcher wants reliable references to some medical topic, they look it up through PubMed.

    I’ve provided the PubMed search strategy my spouse used, and 2 of the more recent publications on this topic, with the results. I’ll post additional facts in future posts as needed to repeat the refutation of the more entertaining posters.

    Link to this
  43. 43. softwarematters 9:42 am 05/28/2013

    SugarTax – 42. Good luck refuting what I provided, which includes data UNPUBLISHED – thus that is not available in PubMed, only from the FDA through FOIA requests.

    You are making a straw man here. I never said thar the aren’t published studies that show efficacy. My point is that those studies suffer from publication bias and that when ALL data is taken into account, the efficacy is non existent.

    Link to this
  44. 44. softwarematters 3:19 pm 05/28/2013

    It seems that the denunciation of psychiatry is going mainstream,

    http://mobile.nytimes.com/2013/05/28/opinion/brooks-heroes-of-uncertainty.html

    “The problem is that the behavorial sciences like psychiatry are not really sciences; they are semi-sciences. The underlying reality they describe is just not as regularized as the underlying reality of, say, a solar system.”

    “If the authors of the psychiatry manual want to invent a new disease, they should put Physics Envy in their handbook. The desire to be more like the hard sciences has distorted economics, education, political science, psychiatry and other behavioral fields. It’s led practitioners to claim more knowledge than they can possibly have. It’s devalued a certain sort of hybrid mentality that is better suited to these realms, the mentality that has one foot in the world of science and one in the liberal arts, that involves bringing multiple vantage points to human behavior.”

    EXACTLY.

    Link to this
  45. 45. SugarTax 5:15 pm 05/28/2013

    @43. softwarematters

    “Good luck refuting what I provided, which includes data UNPUBLISHED”

    In short, you re unable to warrant your claims.

    “You are making a straw man here.”

    Nope. I’m just publishing the facts.

    “My point is that those studies suffer from publication bias”

    Substantiate your claims or acknowledge defeat.

    “when ALL data is taken into account, the efficacy is non existent.”

    I’ve already posted two studies that show you’re mistaken. How much contradicting evidence will cause you to change your mind?

    One more refutation:

    http://www.ncbi.nlm.nih.gov/pubmed/23160109
    ………………

    Early onset of action and sleep-improving effect are crucial in decreasing suicide risk: the role of quetiapine XR in the treatment of unipolar and bipolar depression.

    Pompili M, Rihmer Z, Gonda X, Serafini G, Sher L, Girardi P.

    Source

    Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center Sant’Andrea Hospital, Sapienza University of Rome, Italy. maurizio.pompili@uniroma1.it

    Abstract

    Although the possibilities of antidepressive pharmacotherapy are continuously improving, the rate of nonresponders or partial responders is still relatively high. Suicidal behavior, the most tragic consequence of untreated or unsuccessfully treated depression, commonly observed in the first few weeks of antidepressive treatment before the onset of therapeutic action, is strongly related to certain symptoms of depression like insomnia. The present paper reviews the newly discovered and well-documented antidepressive effect of quetiapine in bipolar and unipolar depression with special focus on its early onset of action and its sleep-improving effects. Both beneficial effects play an important role in the reduction of suicidal risk frequently observed in depressed patients.

    ………………

    Link to this
  46. 46. SugarTax 5:25 pm 05/28/2013

    SugarTax – Keep in mind that I’m working from an initial list of 200. I can always get the other 1,367 abstracts if it will make you feel good.

    Link to this
  47. 47. Chryses 6:27 pm 05/28/2013

    softwarematters,

    Yesterday, I pointed out that you incorrectly identified a fact as a non sequitur.

    Today I will point out that your argument, “It seems that the denunciation of psychiatry is going mainstream” is an example of a logical fallacy, the “Appeal to Popularity”

    http://www.nizkor.org/features/fallacies/appeal-to-popularity.html

    The Appeal to Popularity has the following form:
    1. Most people approve of X (have favorable emotions towards X).
    2. Therefore X is true.

    You’re wrong again.

    Link to this
  48. 48. portland17 6:55 pm 05/28/2013

    While a comparison to astrology is perhaps odious and not applicable, the idea that psychiatry in the main provides effective treatments for its various and subjectively-described “disorders” is highly questionable. The majority of research is 4-8 week trials which look almost exclusively at symptom reduction (i.e. does the person feel “less bad” or behave “less psychotically” than before). When we look at long-term outcomes, the results are, to put it mildly, a big disappointment. Start with the WHO studies in the ’90s that show schizophrenia outcomes to be an order of magnitude better in countries like India and Brazil than the US and the UK, the main variable being that they use a lot less psychotropic medication. Add that the best schizophrenia outcomes in the world are in northern Finland, where they use the “Open Dialog” approach, which emphasizes communication and connection and honesty and de-emphasizes labels and drugs, to the point that 80% of the clients recover to employment, education, community participation, and normal family/community relationships, the vast majority of whom never took psych drugs or took them only briefly. Add to that the long-term research by Martin Harrow showing that even poor-prognosis psychotic clients did better off medication than the good-prognosis clients did on medication. And that’s just the evidence base for psychosis. Similarly poor or indiscriminate outcomes exist for psychiatric drug treatment of depression, bipolar disorder, and ADHD (for the latter, see the Oregon State University Medication Effectiveness Study, which showed no evidence of any long-term benefits for stimulant use, other than a slight reduction in accidents for those using stimulants). All of this is articulately outlined, with hundreds of references, in Robert Whitaker’s book, “Anatomy of an Epidemic.” It completely supports the author’s concerns.

    I appreciate the address of this issue from a point of view of medical ethics. We are not supposed to lie to our clients, nor are we supposed to harm them with our treatments. If we can’t help, we should stand aside and “do no harm.” But the psychiatric profession does harm all the time, to the tune of the “seriously mentally ill” dying 20-25 years earlier than the general population.

    Thanks for the great article. Those who wish to criticize it, I strongly suggest you read Anatomy of an Epidemic first, and then see what you think.

    — Steve

    Link to this
  49. 49. softwarematters 9:43 pm 05/28/2013

    SugarTax – 46,

    What you have a tough time understanding (I don’t blame you) is that the published data available in PubMed IS NOT all the clinical trial data there is. This is evident here,

    ““My point is that those studies suffer from publication bias”

    Substantiate your claims or acknowledge defeat.”

    The two studies I provided used data coming from Freedom of Information Act request. For those who don’t know what this is (I am not sure if you are one), http://en.wikipedia.org/wiki/Freedom_of_Information_Act_%28United_States%29 “is a federal freedom of information law that allows for the full or partial disclosure of previously unreleased information and documents controlled by the United States government”

    The drug companies are required to submit the RAW data of ALL trials -ie, not only the analysis but ALL RAW DATA- to the FDA as part of the drug approval process. This data might, or might not, be then made public in the form of studies that are published in the peer reviewed literature. The two studies I mentioned required the data directly from the FDA, then performed the analysis combining the raw data from both published and unpublished studies.

    If you have scientific background, you could read both studies and you’ll understand what I am saying. By definition, you cannot refute these studies with studies that show up in PubMed because the ones that show up in PubMed are those biased to show a positive result (that was one of the findings of EH Turner). And again, all this is legal because: 1) the FDA has a lower standard for the approval of psychiatric drugs than for other drugs, 2) while the companies are required to submit all their trial data to the FDA, they are not required to make that data public in the form of PubMed indexed studies.

    Chryses – 47.

    The expert in logical fallacies it’s you. It cannot get more fallacious than appealing to an Oxford dictionary definition to claim victory in a matter in which there is so much scientific controversy.

    I did not appeal to popularity, I just explained that the matter is contentious and that your reasoning is fallacious because it is based on a false assumption, namely, that the epistemology of the tissue is the same as the epistemology of the mind.

    portland17 – 48

    CannotSay here. I think that the comparison with astrology is perfectly appropriate. Enough of giving these people a consideration and deference they don’t deserve. Over 200 years they have given us Drapetomania, Female Hysteria, Lobotomy, ECT, Chemical Lobotomies (ie, neuroleptic drugs), SSRIs (with their increase in risk of suicide). At least astrology has not killed anyone, that I am aware of. I rather go to an isolated island with an astrologer than with a psychiatrist.

    Link to this
  50. 50. SugarTax 9:18 am 05/29/2013

    softwarematters,

    “PubMed IS NOT all the clinical trial data there is”

    As I did not claim that to be true, it is inappropriate to suggest that I did. PubMed remains the principle access tool to MEDLINE, which is a primary source for peer-reviewed, academic, medical publications. Other sources of information about the results of drug testing trials exist (ref here the Cochrane Central Register of Controlled Trials, from the article by Turner, Matthews, et al. See below). This is what I explained at #42 to CurrentOutlook. These include the studies I’ve provided to show that the medications prescribed by psychiatrists are effective. This in turn, shows that you are mistaken when you claim otherwise. Aren’t you the one who accuses others of the “Straw Man” argument?

    “The two studies I mentioned required the data directly from the FDA, then performed the analysis combining the raw data from both published and unpublished studies.”

    No, they did not. You are mistaken.

    The study titled “Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy” compared the results of the published and unpublished studies, not the raw data. I quote from the paper, “we compared the published outcomes with the FDA outcomes”. Go read the 2008 article: http://www.nejm.org/doi/full/10.1056/NEJMsa065779

    You appear to be unfamiliar with the subject material – Meta-analysis.
    http://en.wikipedia.org/wiki/Meta-analysis

    The study titled “Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration” evaluated the efficacy of FOUR, count ‘em, FOUR medications. “We obtained data on all clinical trials submitted to the US Food and Drug Administration (FDA) for the licensing of the four new-generation antidepressants for which full datasets were available”. Go read the 2008 article: http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045

    You’ve made the mistake of taking the results of an analysis of four medications, and extrapolating it to apply to all anti-depressants. You appear to be unfamiliar with the subject material – Extrapolation. Note in particular, the second clause of the second sentence of the first paragraph, “extrapolation is subject to greater uncertainty and a higher risk of producing meaningless results”.
    http://en.wikipedia.org/wiki/Extrapolation

    “the ones that show up in PubMed are those biased to show a positive result (that was one of the findings of EH Turner).”

    The data does not support that claim. You are mistaken.

    “Our literature-search strategy consisted of the following steps: a search of articles in PubMed, a search of references listed in review articles, and a search of the Cochrane Central Register of Controlled Trials; contact by telephone or e-mail with the drug sponsor’s medical-information department; and finally, contact by means of a certified letter sent to the sponsor’s medical-information department, including a deadline for responding in writing to our query about whether the study results had been published. If these steps failed to reveal any publications, we concluded that the study results had not been published”
    http://www.nejm.org/doi/full/10.1056/NEJMsa065779#t=articleBackground ; “Data from Journal Articles”
    As you now know, PubMed was but one of five sources of published literature. Further, you cannot identify what portion of the published literature was drawn from PubMed. As a result, you cannot identify it as “biased to show a positive result”. Were the published results drawn exclusively from one source, you could infer that conclusion; as it is not, you cannot. You appear to be unfamiliar with the subject material – Statistical Analysis, sample selection.

    To continue, even were your claim true, and I have shown above that it is in fact false, your point is irrelevant; the published trials show the efficacy of the medications. The non-publication of tests that support your theory does not change the results of the tests that falsify it.

    Having now reviewed the foundation of your claims in some detail, and having identified the flaws in both what you present as supporting data, and your reasoning based upon that data, we may conclude that your claim, “psychiatry is a pseudo-science on the order of astrology” is false, and that in your belief you remain mistaken.

    Link to this
  51. 51. Chryses 1:21 pm 05/29/2013

    Softwarematters (49),

    “The expert in logical fallacies it’s you …”

    I thank you for the compliment, but one need not be an expert in logical fallacies to identify mistakes in your posts. Two were quite obvious:

    MISTAKING A FACT FOR A CONCLUSION.
    A non sequitur is an argument in which its conclusion does not follow from its premises. In other words, a logical connection is implied where none exists.
    @33 “you pull off a non sequitur”
    You mistook a statement of fact (a dysfunctional mind is a diseased mind) as a conclusion. I provided the definition to correct your mistake.
    http://oxforddictionaries.com/us/definition/american_english/disease
    Here are 2 other examples of how people use the word “disease” to corroborate the OED definition.
    http://diseases.disease.com/
    http://www.merriam-webster.com/dictionary/disease

    APPEAL TO POPULARITY
    @44 “It seems that the denunciation of psychiatry is going mainstream,”
    What is meant when using the expression “going mainstream”? In contemporary English it means to become popular or common (http://answers.yahoo.com/question/index?qid=20110103202331AAuw9Bh ). That is to say that “it”, in this instance “the denunciation of psychiatry” is in the process of moving from a POV of a few people to a POV held by many. So yes, your post invoked an Appeal to Popularity, which has the following form:
    1. Most people (remember “going mainstream”?) approve of X (have favorable emotions towards X).
    2. Therefore X is true.

    “It cannot get more fallacious than appealing to an Oxford dictionary definition to claim victory in a matter in which there is so much scientific controversy.”

    There’s nothing at all fallacious in defining the terms used in discourse, in this instance, “disease”. Here are the references are again; note that a disease, as used by English speaking people, is not be limited to physical difficulties. Note also that the non-physical nature of the noun is not limited to one dictionary; it is the common use of the word.
    http://oxforddictionaries.com/us/definition/american_english/disease
    http://diseases.disease.com/
    http://www.merriam-webster.com/dictionary/disease

    Further, there is no scientific controversy about what constitutes a disease; when a living organism differs from the norm of that organism sufficiently as to become dysfunctional, the organism is diseased. Finally, I did not claim victory, I merely pointed out that you were wrong. Read my post #37, you’ll see I’m correct.

    “I did not appeal to popularity …”

    Yes, you did, as demonstrated above.

    “… I just explained that the matter is contentious …”

    No, it isn’t, as described above by 2 dictionary definitions, and 1 example of its use.

    “… your reasoning is fallacious because it is based on a false assumption, namely, that the epistemology of the tissue is the same as the epistemology of the mind.”

    I did not suggest that the epistemology of the tissue is the same as the epistemology of the mind. Epistemology is the theory of knowledge, especially with regard to its methods, validity, and scope. Epistemology is the investigation of what distinguishes justified belief from opinion. (http://oxforddictionaries.com/us/definition/american_english/epistemology ).

    The determination if an organism is diseased is usually based upon the presence or absence of symptoms (check out the dictionary definitions above), and these symptoms may have a physical or mental origin.

    You’re wrong again.

    Link to this
  52. 52. softwarematters 2:47 pm 05/29/2013

    SugarTax – 50,

    Now that you lost, you are trying to pull off another semantics trick? Such this this,

    “Having now reviewed the foundation of your claims in some detail, and having identified the flaws in both what you present as supporting data, and your reasoning based upon that data, we may conclude that your claim, “psychiatry is a pseudo-science on the order of astrology” is false, and that in your belief you remain mistaken.”

    David Brooks (http://mobile.nytimes.com/2013/05/28/opinion/brooks-heroes-of-uncertainty.html) called it “semi-science”. Pseudo science works for me. You have not refuted anything, see below.

    “PubMed remains the principle access tool to MEDLINE, which is a primary source for peer-reviewed, academic, medical publications. Other sources of information about the results of drug testing trials exist (ref here the Cochrane Central Register of Controlled Trials, from the article by Turner, Matthews, et al. See below). This is what I explained at #42 to CurrentOutlook.”

    Actually, whether implicitly or explicitly, you implied that PubMed is all there is based on the work your wife does. You were prepared to give hundreds of PubMed citations.

    The studies that I provided use RAW data submitted directly to the FDA. By the very nature, no PubMed study is going to refute that.

    “No, they did not. You are mistaken.”

    From the Irving Kirsch study,

    “Following the Freedom of Information Act (FOIA) [7], we requested from the FDA all publicly releasable information about the clinical trials for efficacy conducted for marketing approval of fluoxetine, venlafaxine, nefazodone, paroxetine, sertraline, and citalopram, the six most widely prescribed antidepressants approved between 1987 and 1999 [2], which represent all but one of the selective serotonin reuptake inhibitors (SSRIs) approved during the study period.”

    “The study titled “Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy” compared the results of the published and unpublished studies, not the raw data. I quote from the paper, “we compared the published outcomes with the FDA outcomes”. Go read the 2008 article: http://www.nejm.org/doi/full/10.1056/NEJMsa065779

    I am not surprised that you are doing this, since you have a knack for “selective bias” (like your proclamation about PubMed). This is what EH Turner also said,

    ” A 32% increase was also observed in the weighted mean effect size for all drugs combined, from 0.31 (95% CI, 0.27 to 0.35) to 0.41 (95% CI, 0.36 to 0.45).”

    ALL DRUGS COMBINED.

    “You appear to be unfamiliar with the subject material”

    Again, you can spare me from a semantics discussion. While your wife does work for people who gets their stuff published, I do the scientific work that gets published. I hope you understand that you are hardly going to convince me with selective quotation. It is obvious by now that you are not a scientist; your comment below proves is beyond reasonable doubt.

    “You’ve made the mistake of taking the results of an analysis of four medications, and extrapolating it to apply to all anti-depressants. You appear to be unfamiliar with the subject material – Extrapolation.”

    Actually you are again showing your lack of scientific background. These medications are all SSRIs, which are “me too” drugs. They are all based on the same chemical and the same effect: selective serotonin reuptake inhibition.

    Extrapolation from analyzing all raw data submitted to the FDA is warranted. What is not warranted is to extrapolate from individual studies that show up in PubMed because said studies suffer from selective bias. If you had a scientific background, you’d understand this.

    “To continue, even were your claim true, and I have shown above that it is in fact false, your point is irrelevant; the published trials show the efficacy of the medications. The non-publication of tests that support your theory does not change the results of the tests that falsify it.”

    Actually, this is where your own lack of scientific background shows its true colors. When you refuse to include data in the analysis because you know that data will bias the study, you are in fact doing what in many fields would be considered “scientific misconduct”. The practice that you just described has a name, it’s called http://en.wikipedia.org/wiki/Data_dredging “Data dredging (data fishing, data snooping) is the inappropriate (sometimes deliberately so) use of data mining to uncover misleading relationships in data. Data-snooping bias is a form of statistical bias that arises from this misuse of statistics. Any relationships found might appear valid within the test set but they would have no statistical significance in the wider population.”

    Which is precisely the problem these published trials have and that the two studies that I mentioned uncovered.

    “your belief you remain mistaken.”

    As I said above, what this discussion has shown is that you are not a scientist. You have provided yourself explanation of why psychiatry is such a fraud without knowing it. That explanation that the publishing of antidepressant trial data engages deliberately in “data snooping” was priceless. That’s exactly my point!

    Link to this
  53. 53. SugarTax 4:50 pm 05/29/2013

    @52. softwarematters,

    “David Brooks (http://mobile.nytimes.com/2013/05/28/opinion/brooks-heroes-of-uncertainty.html) called it “semi-science”. Pseudo science works for me. You have not refuted anything, see below.”

    Interesting, but irrelevant to the topic. Still, if posting irrelevancies makes you feel good about yourself, have t it.

    “Actually, whether implicitly or explicitly, you implied that PubMed is all there is based on the work your wife does. You were prepared to give hundreds of PubMed citations.”

    So is that “implicitly implied”, or “explicitly implied”? LOL! Foolish nonsense. I can provide many more than that. And that was spouse, not wife. Another mistake!

    Link to this
  54. 54. Chryses 5:33 pm 05/29/2013

    SugarTax (53),

    “Interesting, but irrelevant to the topic. Still, if posting irrelevancies makes you feel good about yourself, have t it.”

    While softwarematters quote from the political and cultural commentator is amusing, and irrelevant.

    It is another Appeal to Popularity, a logical fallacy.

    Link to this
  55. 55. SugarTax 6:50 pm 05/29/2013

    @52. softwarematters

    “What is not warranted is to extrapolate from individual studies that show up in PubMed”

    I have not done so. All I have done is to show that they’re efficacious, which shows you’re mistaken.
    Again.

    Link to this
  56. 56. Chryses 7:08 pm 05/29/2013

    SugarTax,

    “It is obvious by now that you are not a scientist; your comment below proves is beyond reasonable doubt.”
    “you are again showing your lack of scientific background.”
    “this is where your own lack of scientific background shows its true colors”

    These are examples of another logical fallacy: The Appeal to Ridicule
    http://www.nizkor.org/features/fallacies/appeal-to-ridicule.html

    The Appeal to Ridicule is a fallacy in which ridicule or mockery is substituted for evidence in an “argument.” This line of “reasoning” has the following form:
    1. X, which is some form of ridicule is presented (typically directed at the claim).
    2. Therefore claim C is false.

    This sort of “reasoning” is fallacious because mocking a claim does not show that it is false. This is especially clear in the following example: “1+1=2! That’s the most ridiculous thing I have ever heard!” In this instance, the ridicule is the unwarranted claim that you are unfamiliar with Science.

    Link to this
  57. 57. SugarTax 7:40 pm 05/29/2013

    softwarematters

    Here is the latest installment of the refutation-by-peer-reviewed-studies

    ………………..

    http://www.ncbi.nlm.nih.gov/pubmed/22404233

    Acta Psychiatr Scand. 2012 Sep;126(3):186-97. doi: 10.1111/j.1600-0447.2012.01847.x. Epub 2012 Mar 9.

    A decision analysis of long-term lithium treatment and the risk of renal failure.

    Werneke U, Ott M, Renberg ES, Taylor D, Stegmayr B.
    Division of Psychiatry, Department of Clinical Sciences, Umeå University, Sweden. uwerneke@gmail.com

    Abstract
    OBJECTIVE:
    To establish whether lithium or anticonvulsant should be used for maintenance treatment for bipolar affective disorder (BPAD) if the risks of suicide and relapse were traded off against the risk of end-stage renal disease (ESRD).
    METHOD:
    Decision analysis based on a systematic literature review with two main decisions: (1) use of lithium or at treatment initiation and (2) the potential discontinuation of lithium in patients with chronic kidney disease (CKD) after 20 years of lithium treatment. The final endpoint was 30 years of treatment with five outcomes to consider: death from suicide, alive with stable or unstable BPAD, alive with or without ESRD.
    RESULTS:
    At the start of treatment, the model identified lithium as the treatment of choice. The risks of developing CKD or ESRD were not relevant at the starting point. Twenty years into treatment, lithium still remained treatment of choice. If CKD had occurred at this point, stopping lithium would only be an option if the likelihood of progression to ESRD exceeded 41.3% or if anticonvulsants always outperformed lithium regarding relapse prevention.
    CONCLUSION:
    At the current state of knowledge, lithium initiation and continuation even in the presence of long-term adverse renal effects should be recommended in most cases.
    © 2012 John Wiley & Sons A/S.
    PMCID: PMC3440572 Free PMC Article

    ………………..

    Given this data, let us review your post #52

    “These medications are all SSRIs, which are “me too” drugs. They are all based on the same chemical and the same effect: selective serotonin reuptake inhibition.

    Extrapolation from analyzing all raw data submitted to the FDA is warranted.”

    As lithium is not a member of that class of medications (it decreases norepinephrine (noradrenaline) release and increases serotonin synthesis), and as it is effective in treating depression, it bears repeating:

    You’ve made the mistake of taking the results of an analysis of four medications, and extrapolating it to apply to all anti-depressants. You appear to be unfamiliar with the subject material – Extrapolation.

    You remain mistaken.

    Link to this
  58. 58. softwarematters 7:59 pm 05/29/2013

    Chryses – 52

    I don’t have any time to waste with you. You might think that you have made smart points, but the only thing that you have shown, for those who might harbor doubts, is how ignorant you are about the matter at hand. A semantic/sophistic trick is not going to cut it. End of the story.

    Link to this
  59. 59. Judy Stone in reply to Judy Stone 8:48 pm 05/29/2013

    Yes, @softwarematters, @SugarTax @Chryses, it’s going to be the end of the story. Been interesting watching you, but time to call it quits on this…Perhaps you can add something new to a future post. Closing this convo now. Thanks.

    Link to this
  60. 60. portland17 10:41 pm 05/29/2013

    I will note that Sugartax did not respond at any point to my comments regarding LONG-TERM outcomes. All the studies cited are about short-term symptom reduction, not long-term quality of life issues. And the last views lithium as the “treatment of choice”, but only assuming that drugs are the only choice. There is no comparison to no treatment or to other non-drug options. And there probably never will be. Look at what happened to Loren Mosher and Soteria House.

    Psychiatry will never be interested in the full range of scientific inquiry, because it always limits itself to symptom reduction by drug intervention as its only objectives and only measures. There are a lot of other ways to look at the question of mental and emotional distress.

    — Steve

    Link to this
  61. 61. NewGatsby 6:51 am 05/31/2013

    portland17,

    How long is long-term? To quote from the study you mentioned in SugarTax’s post “Twenty years into treatment, lithium still remained treatment of choice.”

    OBJECTIVE:
    To establish whether lithium or anticonvulsant should be used for maintenance treatment for bipolar affective disorder (BPAD) if the risks of suicide and relapse were traded off against the risk of end-stage renal disease (ESRD).

    CONCLUSION:
    At the current state of knowledge, lithium initiation and continuation even in the presence of long-term adverse renal effects should be recommended in most cases.

    Link to this
  62. 62. BookSpine 1:23 pm 05/31/2013

    portland17,

    I followed the link you’re referring to in SugarTax’s post, and the study wasn’t comparing the results of long-term lithium medication to no treatment or to other non-drug options. It was assessing if lithium should be used for maintenance treatment of bipolar affective disorder when the risks of suicide and relapse were traded off against the risk of end-stage renal disease. That seems to me to be a reasonable balance to evaluate. Just because lithium saves lives by reducing the frequency and severity of suicidal thoughts doesn’t mean it doesn’t have unwanted side effects.

    Depending upon the patient and the severity of the symptoms that brought about seeking medical treatment, psychotherapy or other “talk, insight-based” therapies as Dr. Stone calls them, might be effective in treating the mental illness. Also depending upon the patient, there are other effective medications available to reduce the frequency and severity of suicidal thoughts that may be more useful than lithium. Psychiatrists have prescribed lithium to help treat bipolar affective disorder for many years now, as this long-term study shows, but it is not the only therapy available.

    Link to this
  63. 63. CurrentOutlook 7:24 pm 05/31/2013

    I suppose that forming an opinion on this topic boils down to deciding what constitutes evidence, and the degree of confidence one places upon that “evidence”. Based upon what I’ve read from the linked publications by the two different POVs here, it seems to me that the questions raised about the effectiveness of both the long-term and short-term use of the medications prescribed by psychiatrists have been answered; they work when used correctly.

    I will say that in all my years in IT I have not seen an uglier search syntax that that used by PubMed. Talk about a YAFIYGI editor! (You Asked For It You Got It) I was under the impression that psychiatrists used medications to augment their “talk, insight-based” therapies, but it seems that is old fashioned idea.

    As for Dr. Lieberman’s defense of his profession, I’m minded of the observation that liberals often become conservative when their specialty is criticized.

    Link to this
  64. 64. portland17 11:07 pm 06/4/2013

    That is actually a good point, CO. The kinds of outcomes I’m talking about have to do with quality of life issues, whereas the kind of outcomes measured in the kind of treatment comparisons quoted are focused on symptom reduction. I think this is where a lot of the controversy lies – supporters of psychiatry talk about symptom reduction, whereas its critics are more interested in the long-term impact on the lives of those receiving treatment. I personally think the latter is the more important thing to measure.

    1) Long-term employment prospects and social adjustment for those diagnosed with schizophrenia are better in developing nations, such as India and Brazil, vs. industrialized nations, according to two separate studies by the WHO in the ’90s (they apparently did the second study because the professionals refused to believe the first one).

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632419/

    2) Martin Harrow also showed better schizophrenia outcomes in terms of employment, relationships, and general social normalization for those receiving no medication, in a long-term study that has now proceeded for over 20 years with ongoing similar results:

    http://www.psychrights.org/Research/Digest/NLPs/OutcomeFactors.pdf

    3) The Open Dialog approach in Finland has shown 80% social recovery rates, using a model that is primarily focused on relationships and communication, using drugs only as an adjunct therapy and for as short a time as possible. Only 20% of their ongoing clientele remain on medication years afterwards, with most of the 80% employed and functioning well in society on no medication at all.

    http://www.iarecovery.org/documents/open-dialogue-finland-outcomes.pdf

    That’s what I mean by long-term outcomes. Not symptom reduction, but re-integration into a quality life not dominated by their “disease.” Despite years of promises, American psychiatry can’t even come close to these figures. Last I heard, the full recovery rate for US treated schizophrenics was under 10%.

    And it’s not just schizophrenia where this applies. Parents of children diagnosed with ADHD are often told that untreated “ADHD” children have higher rates of school dropout rates, delinquency, teen pregnancy rates, lower test scores, lower self-esteem than their “normal” counterparts. Only one problem – TREATED “ADHD” children had the same outcomes, according to a wide range of reviews of the literature over many years, starting with Barclay and Cunningham in 1978, including Swanson et al’s “review of reviews” in 1993, and culminating in the OSU Medicaion Effectiveness Study in the early 2000′s, which concluded that no long-term outcome of consequence was improved by long-term stimulant treatment. The only improvement shown was in reduced accidents while taking stimulants. Academic and professional success, delinquency and crime, self-esteem, dropout rates, none of these were improved in the slightest by years of stimulant use. Attached is an excellent essay by Alan Sroufe, a long-time professional ADHD researcher and psychiatrist who came to the same conclusions:

    http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html?pagewanted=all&_r=0

    Of course, we can all agree that in the short-term, stimulants do improve focus for a good percentage of the population, ADHD diagnosed or not. But that’s not a good enough reason to employ them long term. If kids are not benefiting academically, they’re assuming a risk with no benefit, and that is counter to everything we are taught medicine is supposed to represent.

    I could go on, but you get the idea. If you want to learn more about this important topic, read “Anatomy of an Epidemic” by Robert Whitaker. It’s the only book I know that approaches this question of long-term outcomes vs. short-term symptom reduction in a scientifically honest way.

    This is not to say that Lithium can’t reduce suicidal behavior in the short run – it has been shown to do that, much moreso than the antidepressants, interestingly. But does it improve long-term quality of life? That is the question I think the psychiatrists have avoided for years, and Dr. L does nothing to address it, nor do most of the posters here.

    Interested in your response.

    —- Steve

    Link to this
  65. 65. CurrentOutlook 6:23 am 06/6/2013

    portland17,

    Yes, it does seem that you re focused on a different topic, quality of life, than the prior reduction in suicidal behavior topic.

    I would suggest that there is an intersection though; a successful suicide reduces the quality of life to zero.

    SugarTax’s post (#57, 7:40 pm 05/29/2013) references a 20 year evaluation of lithium treatment as successful, so I think the notion that its effectiveness is limited to reducing suicidal behavior in the short run is false.

    I’m pleased to read in you post that the Finns and I share similar opinions about the correct application of psychiatric practice, where relationships and communication are “talk therapy”, and medications are prescribed in conjunction with them.

    Link to this
  66. 66. portland17 12:12 pm 06/7/2013

    Hey, you don’t have to talk to me about suicide prevention – I used to supervise a suicide hotline for several years. But even there, the use of medications is highly overrated, in my view. I was very successful in talking people through suicidal thoughts, even pretty severe ones, and I had a corps of volunteers, yes volunteers, who were generally also quite successful in talking folks through suicidal episodes by understanding what the person was in distress about and assisting them in finding alternative ways to approach the problem. This kind of therapy has largely been supplanted by knee-jerk use of antidepressants, which as we know can also cause or exacerbate suicidal thinking or actions even in folks who were not. Again, I’m not saying there is no role for these agents, only that it should not be the FIRST LINE TREATMENT, which is what has become the case for most people seeking help.

    I would also suggest you read more closely the studies I quoted on the long-term impacts of antipsychotics (reading Anatomy of an Epidemic would give you a thorough grounding). The research is suggesting that while antipsychotics may decrease symptoms in the short run, maintaining large numbers of sufferers on antipsychotics in the long run DECREASES their chances of recovery!! This is a very serious situation and deserves close attention, but it has been known since the mid-1990s and has been ignored by the psychiatric community. I can only presume that conflicts of interest entered in and this “inconvenient truth” had to be ignored for the establishment to continue to have power and make money. Hence, the idea of medication provided in conjunction with therapy isn’t really what the Finns are up to – the medication is an ADJUNCT to the talk therapy, which is considered PRIMARY TREATMENT. Their idea is to not use drugs if possible, and if not possible, to use them in the lowest dosages and for the shortest time possible. This, in my view, should be the standard of care for ALL psych drugs.

    The ADHD example also stands to support this. There are dozens of non-pharmacologic interventions that can be employed to address lack of attention in the classroom, from using open classroom settings to positive reinforcement programs to paradoxical approaches for oppositional behavior to gifted classrooms for smart kids to simply waiting another year before starting the child in school. ALL of these options should be considered BEFORE exposing kids to the risk of psychotropic drugs, because none of them carry any such risk. And even if medication is used, science tells us that it is only effective for 1-2 years, after which point, the unmedicated kids do just as well. So the point should be to address the underlying needs of the child through changing the environment, expectations, motivational systems, skill sets of the child, etc., with medication used only as an adjunct in severe cases, with the goal to use as little as possible and to wean the child off as soon as possible. That’s what the science tells me.

    If you simply focus on symptom reduction, drugs will beat behavioral/social interventions for ADHD most of the time (though the open classroom is amazingly effective in almost eliminating “symptoms”, with professionals unable to distinguish ADHD from “normal” children in that setting). But if you focus on long-term outcomes, it’s clear that drugs have no impact and we need to focus on other things that actually make a difference in quality of life.

    Suicide intervention is short-term. While acute care is needed, it is not sufficient. Psychiatry seems to have decided that providing acute care and nothing else is the answer. The results are pretty poor, considering that our psychotic sufferers are better off if the get their treatment in Brazil.

    —- Steve

    Link to this
  67. 67. CurrentOutlook 2:08 pm 06/9/2013

    portland17,

    “The research is suggesting that while antipsychotics may decrease symptoms in the short run, maintaining large numbers of sufferers on antipsychotics in the long run DECREASES their chances of recovery!!”

    I very much doubt research is suggesting that the outcome of any antipsychotic medication is influenced by the number of patients consuming the medication.

    “Psychiatry seems to have decided that providing acute care and nothing else is the answer.”

    By providing medication to alter the mental (brain) state (activities) which motivate suicide, the probability of suicide, an event which has a brief duration, but extended results, is reduced. That seems to be a reasonable initial goal to me. I don’t get the impression that the psychiatric profession’s considered opinion is “nothing else is the answer”. I do get the impression that the insurance companies are more willing to pay for the drugs than they are for the counseling. Is that the thrust of your criticism?

    “The results are pretty poor, considering that our psychotic sufferers are better off if the get their treatment in Brazil.”

    You may find it valuable to read the following criticism and review the referenced publications.

    “The two multi-country WHO schizophrenia outcome studies, which claimed that individuals with schizophrenia in developing countries had much better outcomes than those in developed countries, were relied upon heavily by Whitaker, both in this book and in his previous writings (Whitaker, 2004). Whitaker claimed that the patients in developing countries did better because they were less likely to be treated with antipsychotic medication. The authors of the WHO studies reported “a marked predominance of favourable outcomes in the centres in developing countries” and a “considerably more favourable [course] in developing countries” (Sartorius et al., 1986). These claims were heavily criticized at the time they were first published (e.g. Stevens, 1986) because it was alleged that the WHO centers in the developing countries had included many individuals who did not have true schizophrenia. Rather they had included many patients with acute reactive psychosis which has a much better outcome than true schizophrenia.”
    and

    “The WHO claim of better outcomes for schizophrenia in developing countries has continued to be criticized over the years and has now been largely discredited. Cohen et al. (2008) examined 23 schizophrenia outcome studies in 11 low-and-middle income countries and concluded that there is “a need to reexamine the conclusions of the WHO studies.” Messias et al. (2007) suggested that an increased mortality among the sickest patients in developing countries may have created an illusion that outcomes among other patients were better. And most recently Teferra et al. (2011) reported five years outcome data on 321 schizophrenia patients in rural Ethiopia with results sharply at variance with the WHO results. Faced with such criticisms, the authors of the WHO studies have recently modified their claims, stating that “we do not argue that the prognosis of schizophrenia in developing countries is groupwise uniformly milder” and acknowledging that “the proportions of continuous unremitting illness…did not differ significantly across the two types [developed and developing] of settings: (Jablensky & Sartorius 2008).”
    http://www.treatmentadvocacycenter.org/index.php?option=com_content&id=2085

    This is not to say that you are necessarily wrong, but to point out that there is something less than consensus on this issue, and that you may be overly reliant on a single resource to provide, as you put it, “a thorough grounding” on the subject.

    Link to this
  68. 68. portland17 1:21 am 06/16/2013

    Of course, I have already read these criticisms, and find them shallow and self-serving. They don’t refute the evidence, they merely provide other semi-plausible explanations. Which they’re entitled to do, but that doesn’t make it science. The fact of the matter is, there are dramatically better recovery rates in Brazil and India than there are in the USA. And we use plenty of drugs here, and they use very little there. Correlation is not causation, but it ought to give any scientific thinker great pause, to a greater extend than coming up with some alternate explanation and dismissing the studies as unimportant.

    I don’t think science runs on consensus. It runs on facts and the ability to predict the results based on the same circumstances. The WHO study was done twice, because it wasn’t trusted or believed the first time. The second study replicated the results of the first almost completely. Is psychotropic drug use the only variable? Certainly not. Many cultures are much more accepting of psychotic behavior or thinking and such as people are not ostracized or treated in prejudicial ways, as they are in the USA, just for an example of another difference. Certainly, approach to diagnosis might be a big variable, but that only reinforces the subjective nature of these so-called “mental disorders” as primarily social constructs that explain very little. No such conflict of opinion occurs on issues such as broken legs, for instance, nor on the reactions of hydrogen and oxygen to create water. Schizophrenia is a pretty shaky scientific concept to begin with, and it should not cause us great surprise that it is apprehended differently in different cultures.

    As to alternatives, it’s true insurance company payments come into play, as less and less therapy is reimbursable. But in my direct professional experience (and I have a lot of it), most psychiatrists don’t even bother with psychotherapy these days. There was a recent New Yorker article by a psychiatrist talking about how his practice has changed and he doesn’t talk to people about their life circumstances, he pretty much just prescribed. In fact, I once talked to a psychiatrist about a client he’d been seeing for 15 years that we were seeing in our emergency service. He said she was an intractable case of depression, and they’d tried everything, and gave me a long list of drugs he’d prescribed. I asked him what her original situation was that prompted her to seek help. He said, “What?” I said, “What was she originally depressed about that caused her to come to your office?” He said, “Gosh, I don’t know!” Said in a tone of incredulity that suggested it was odd that I would ask him such a meaningless question. He’d tried everything, except asking her “What are you sad about?” Pretty short term, symptom-based thinking to me.

    I wish he were unique, but he is not. I work with foster kids, most of whom have a long list of reasons to be depressed, anxious, angry, etc. The majority of psychiatrists act only to suppress their “symptoms” and spend little to no time considering the social context of their distress. And predictably, there are some short-term gains, but in the long run, a lot of them don’t get better, and often they get worse and worse. It is almost never considered that the drugs are not working and should be discontinued. Any “symptoms” that emerge following drug treatment are generally treated with more drugs. And after the kids stabilize, the drugs are almost always continued indefinitely, because everyone’s afraid they’ll fall apart if the drugs are discontinued. Nobody seems to consider the possibility that depression/anxiety/anger might be normal reactions to very abnormal situations that these kids find themselves in, and that the solution may not be in suppressing these manifestations, but in normalizing them and helping the child come to terms with the awful circumstances that have led them to this difficult place in their lives.

    It’s also clear that the Harrow study reinforces the observations of the WHO studies, by showing that in the good old US of A, even the “good prognosis” clients who took medication fared worse in the long term than the “bad prognosis” clients who discontinued antipsychotic use early on. Further, studies on the social recovery rates of US-diagnosed schizophrenia patients in the 1950s (before drugs) supported the idea that 60% or more of those hospitalized for schizophrenia were working 5-10 years later. That number today is much, much smaller.

    Harrow was reluctant to draw this conclusion after 15 years of data, but in his recent 20-year review of the same clients, the same patterns were maintained, and he reluctantly acknowledged that we need to take another look at the possibility that while antipsychotics may reduce symptoms in the short run, it is possible in the long run that we are creating more chronic clients by insisting on long-term use of antipsychotics in every case. He definitely does conclude that the outcome for schizophrenia and less serious psychotic disorders is very much related to how long the clients take medication. And he’s a very mainstream psychiatrist.

    Similar results are available for bipolar disorder and in particular for Major Depression, which was not considered a chronic condition until well into the psychiatric drug age.

    You may also be interested to know that the idea of psychosis and/or depression being the result of a simple imbalance in dopamine/serotonin respectively was convincingly discredited in the 1908s, before Prozac was even put on the market. There have been recent admissions by key, mainstream psychiatric opinion leaders that this idea is folklore and that no serious psychiatrist believes it is true. Why is this folklore still promoted by the psychiatric industry if it’s known not to be true?

    And that there is a well-understood physiological mechanism in the brain (neurological up- or down-regulation) that explains WHY it is that drugs might relieve symptoms in the short-term but create more chronic problems in the long run.

    There will never be “consensus” if you read folks like Ron Pies and Jeffrey Liebermann, who are embedded in the system and feel compelled to protect the status quo. This happens in any field when its basic tenets are challenged. The answer is to return to scientific studies. If, as you say, there is something less than consensus on the issue scientifically, then it behooves leaders like Liebermann and Pies to state that with clarity, rather than clinging to their pet theories and saying, “But you haven’t proven it wrong yet, so it’s still right” or “You’re only saying that because you’re an antipsychiatry radical who hates us and the mentally ill we try to help.” There are excellent, solid, scientifically viable reasons to doubt the long-term viability of psychiatric drug intervention, and calling those who point out these conflicting studies bad names is a very immature approach to dealing with genuine scientific conflict.

    Both anecdotal information and scientific studies support great skepticism about the long-term benefits of any psychiatric drug intervention. It is another basic principle of science that it is assumed that there is no effect until an effect is proven (the “null hypothesis”). So it’s not really my job to prove there is not a long-term positive impact of psychiatric drug use – it’s the psychiatric profession’s job to prove that there is. So far, I have seen nothing to demonstrate this benefit for any psychiatric disorder, other than a long list of personal anecdotes, which are easily countered by an equally long list of personal anecdotes from those who feel psychiatric drugs have destroyed their lives. Hence, we should be assuming at this point that there is no long-term benefit. People in the US should be getting LESS disabled as a result of our technology. If they’re staying the same or becoming more disabled over time, we should re-think our use of this technology.

    It seems pretty clear you haven’t read Whitaker’s book. You really need to do that if you want to see the whole range of science behind this issue. I can’t quote all the references he has in the book here. Check it out from the library or buy a copy and read it. You will see what I’m talking about. There is a huge difference between short-term efficacy (does the drug reduce identified “symptoms”) and long-term effectiveness (does the drug improve the long-term quality of the recipient’s life). Which one you focus on will dramatically color your view of whether the current broad-scale use of psychiatric drugs is a helpful or dangerous trend. If you care about the second variable, the science really doesn’t support the use of these agents over the long term. It’s not just the WHO study. It’s the sum of the evidence, and it’s pretty hard to argue with when you read the whole story.

    Read the book!

    —- Steve

    Link to this
  69. 69. Margolioth770 5:54 am 06/16/2013

    This is a comment as well as an invitation for responses.
    I was Director of Psychiatric Inpatient Training at SUNY Downstate which conducted the Ziprazadone track of the CATIE Study.
    I did not encourage my resident-staff to refer patients to the study. I had serious ethical questions about the study which I can elaborate on in the future.
    Lacking my co-operation and the low enrollment census, Downstate was dropped from the CATIE Study.
    After our Chairman retired, the former CATIE co-investigator took the position of Acting Chairman and retaliated in a vicious libel involving coercion, and entrapment, the details of which are now irrelevant.I simply raise them in order to preserve my integrity for the sake of the insidious intent I now suspect regarding the effect of the conclusions of the study on Medicaid (or their HMO-subsidiaries)recipients.
    The Department of Health in New York is using the flimsy and highly questionable “conclusions” of the study to effectively create policy that denies the majority of indigent patients from receiving their drug of choice.
    Highly nuanced second and third-generation Atypicls have now been placed on lists of “non-preferred” drugs.
    This population of patients lack access to those psychiatrists with sufficient supportive staff to dedicate “prior-authorization” on virtually every patient.
    Psychiatrist working with poor and indigent patients with Medicare or Medicaid coverage, are physically and mentally unable to negotiate the beurocracy of “prior authorization” now routinely required to renew Schizophrenic patients`on medications like Zyprexa or Abilify.
    Many of these patients have required multiple hospitalizations and treatment trials, have finally been stabilized, and now hit a bureaucratic red-wall.
    Psychiatrists treating this demographic group have to work multiple jobs, cannot afford office-managers to obtain these special waivers for treatment, and are de-facto persuaded to place chronic, refractory, but stable Schizophrenics on the same conventional high potency D 2-blockers that were used in the 60`s and 70`s.
    When Dr. Lieberman was being sponsored by so many pharmaceutical companies, and witnessing like us, the amazing breakthroughs of the new Atypicals?
    And how could he suddenly, as the most powerful psychiatrist in the country, undercut 20-years of clinical research and empirical observation with the stroke of a pen ?
    And if his science is being applied to that group of patients least capable of advocating for their rights, who are the next targets ?
    My guess, is that if this goes unchallenged, this mock-science will then be applied justify withholding expensive treatments to the elderly population in general, as well as those with other chronic disabling illnesses.

    Link to this
  70. 70. CurrentOutlook 4:46 pm 06/18/2013

    portland17,

    “The fact of the matter is, there are dramatically better recovery rates in Brazil and India than there are in the USA. And we use plenty of drugs here, and they use very little there.”

    That looks to be an example of the “Post hoc ergo propter hoc” logical fallacy
    http://www.nizkor.org/features/fallacies/post-hoc.html

    “Correlation is not causation”

    That, however, is correct.

    “but it ought to give any scientific thinker great pause, to a greater extend[sic] than coming up with some alternate explanation and dismissing the studies as unimportant.”

    It seems that you have made the mistake of interpreting the criticism as “dismissing the studies as unimportant” when, in fact the critic did not do so. He merely pointed out that the authors’’ initial sweeping claim proved to be unsubstantiated, and has now been retracted.

    As for reading the book, I think the peer reviewed academic publications by scientists from PubMed above are quite persuasive, thank you.

    Link to this
  71. 71. portland17 3:15 pm 06/20/2013

    Well, sounds like you have your mind made up, but the book is full of tons of peer-reviewed scientific studies that you don’t appear to be familiar with.

    Bottom line, you appear to be taking the view that the academic research is driving field practice, and my view is that the research is being cherry-picked to avoid a very broad range of research that suggests long-term outcomes are not improved by psychiatric drug use, and may be impaired. I gather you don’t really want to look at that question, either, but I hope you change your mind, because you do seem to be persuaded by data, otherwise, I wouldn’t have wasted my time trying to talk to you about it.

    One last attempt to get your interest: a new article just published by one of the peer-reviewed scientific journals we’re talking about finds that kids in Quebec with ADHD diagnoses and got stimulant treatment did WORSE over time than those who did not.

    Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD?
    Janet Currie, Mark Stabile, Lauren E. Jones
    NBER Working Paper No. 19105
    Issued in June 2013
    NBER Program(s): CH HC HE
    We examine the effects of a policy change in the province of Quebec, Canada which greatly expanded insurance coverage for prescription medications. We show that the change was associated with a sharp increase in the use of Ritalin, a medication commonly prescribed for ADHD, relative to the rest of Canada. We ask whether this increase in medication use was associated with improvements in emotional functioning and short- and long-run academic outcomes among children with ADHD. We find evidence of increases in emotional problems among girls, and reductions in educational attainment among boys. Our results are silent on the effects on optimal use of medication for ADHD, but suggest that expanding medication use can have negative consequences given the average way these drugs are used in the community.

    http://www.nber.org/papers/w19105

    Hope this helps keep your mind open to the possibility that you may not have all the data.

    Been fun talking with you.

    —- Steve

    Link to this
  72. 72. CurrentOutlook 5:47 pm 06/21/2013

    portland17,

    “Bottom line, you appear to be taking the view that the academic research is driving field practice, and my view is that the research is being cherry-picked to avoid a very broad range of research that suggests long-term outcomes are not improved by psychiatric drug use, and may be impaired.”

    As the book advances a particular line of reasoning: “using psychiatric medications causes more problems than it solves”, and as these medications have each been shown to be effective for their target group (e.g. reducing the frequency and intensity of suicidal ideation among depressives), I suggest it is more probable that the book’s author did the cherry-picking to support his position than the bio-medical scientific field at large. Remember that he has a vested interest in advancing that proposition, while the bio-medical scientific field at large does not.

    On the off chance that he is correct, corroborating evidence will accumulate over time.

    Link to this
  73. 73. portland17 12:46 pm 06/22/2013

    Yeah, if anyone bothers to look at the corroborating evidence.

    You don’t seriously think those invested in selling medicine choose carefully which things are published? You actually believe that the “Bio-medical scientific field at large does not” have a vested interest in advancing their view of reality???? Do you have any clue how many billions of dollars the drug companies make every year on these “blockbuster drugs?” And that they fund most of the research, and actually have the ability to make it very hard to find data they don’t want published? And the ability to manipulate the public press to publish what they want?

    And what about the psychiatrists getting MILLIONS of dollars annually from pharmaceutical companies to do “educational presentations” on the benefits of drugs the company funding them wants them to promote? Think they might have a SLIGHT conflict of interest, moreso than a scientific journalist who is trying to scrape together a few bucks from publishing a book that is bound to be attacked by the psychiatric industry?

    You haven’t even commented on the stuff I shared about ADHD. Not a word of any of that is disputed. Every major review of the literature since 1978, including guys like Russell Barclay and James Swanson, who are big proponents of stimulant treatment, have shown that long-term stimulant treatment has NO POSITIVE EFFECT on long-term outcomes. Now we have a big study showing a likely NEGATIVE impact on long-term outcomes. Where’s the NYT article on this one? Why isn’t this changing psychiatric practice worldwide? Because they don’t want it to be true and ignore it, or actively discourage people knowing about or believing in it. Just like they did with the WHO studies that undermined their necessary belief in the benefits of antipsychotics over time.

    But perhaps the more salient point is, why can’t YOU acknowledge what even the most stalwart defenders of stimulants have already acknowledged: there is NO demonstrated long-term benefit of stimulant treatment for ADHD. It’s a short-term symptom-reduction strategy, and it appears to lose any advantage over alternative treatment or no treatment after 2-3 years. This is what the SCIENCE shows. Why don’t you want to believe it?

    And you have no business criticizing a book you haven’t ever read. It’s got tons more hard scientific research in there which you are probably not aware of, as most of it has been kept pretty quiet. So read the book or keep quiet. I’m not interested in your opinions about a subject you haven’t bothered to investigate.

    But it sounds to me as if you’ve already got your mind made up, despite your pretensions of scientific openness, and you really don’t want to believe this data any more than those making big bucks off the sale of pharmaceuticals want you to. If you’re not willing to look at the hard data in front of you, including the obvious conflicts of interest that drive the sale of pharmaceuticals in this country (not just psych drugs), then you will be incapable of shifting your views. I hope perhaps someone else can read this exchange and perhaps READ some of the studies I refer to and come to a more objective conclusion.

    —- Steve

    Link to this
  74. 74. CurrentOutlook 6:43 am 06/23/2013

    portland17,

    “You don’t seriously think those invested in selling medicine choose carefully which things are published? You actually believe that the “Bio-medical scientific field at large does not” have a vested interest in advancing their view of reality???? Do you have any clue how many billions of dollars the drug companies make every year on these “blockbuster drugs?” And that they fund most of the research, and actually have the ability to make it very hard to find data they don’t want published? And the ability to manipulate the public press to publish what they want? ”

    Please excuse me if I fail to agree with the proposition that the generally accepted view is a conspiracy by “them”.

    “You haven’t even commented on the stuff I shared about ADHD.”

    Because that is off-topic. The subject was, as far as I was concerned, about the effectiveness of psychiatric medications that alleviate the frequency and magnitude of suicidal behavior. Ref here posts 66 and before.

    “there is NO demonstrated long-term benefit of stimulant treatment for ADHD.”

    While that may well be true, it remains, as far as I am concerned, off-topic, as ADHD is not Depression. While it is interesting, and possibly warrants its own discussion, it remains off-topic here. Different conditions warrant different treatments with different medications and possibly different outcome expectations.

    “And you have no business criticizing a book you haven’t ever read.”

    Nonsense. Neither you nor I will ever waste our time reading a geology text based on the proposition that the Earth was created with the Cosmos just a few thousand years go. Further, both you and I will feel comfortable criticizing all such books without reading them. And why will we feel comfortable doing so? Because there exists a compelling alternative explanation corroborated by a large body of evidence, that’s why. The same is true in this case.

    “But it sounds to me as if you’ve already got your mind made up”

    Not at all, particularly as time is very much on my side. But if that’s your considered opinion, you are, of course, entitled to it.

    Link to this
  75. 75. portland17 1:20 am 06/25/2013

    Nobody said anything about conspiracies. I’m simply commenting on the very obvious conflicts of interest that might motivate a researcher or two to be less than 100% objective. It’s not a conspiracy, it’s just human nature. If you really think scientists are immune to this, your touching faith in the incorruptibility of human beings is more than a tad naive.

    The topic, as I understood it, was the original author (Lieberman) choosing to label anyone who opposed the DSM 5 as “antipsychiatry” and “stigmiatizing,” and this author’s contention that there are plenty of good reasons to be suspicious and distrustful of the psychiatric industry without having to resort to the very kind of “conspiracy” theory you seem to be accusing me of. Which I think my comments clearly supported. Claiming that the ADHD data is “off topic” appears to me to be an evasive maneuver of a person who has nowhere to hang his metaphorical hat.

    The “large body of evidence” you have provided seems mostly limited to a couple of studies on lithium, which I took no issue with whatsoever, except to point out that they focused on suicide prevention, which is to me a short-term outcome by any reasonable measure (even if preventing suicide does have long-term impacts by extension). We can happily disagree on the definition of short- vs. long-term outcomes.

    But if there’s such a large body of evidence supporting the current paradigm, where’s the evidence to counter the solid body of evidence I just provided regarding ADHD? If the body of evidence supporting long-term use of stimulants is as flimsy as I’ve shown it to be, what makes you think that the other evidence you have such faith in is complete? I’ll wager that you had no idea of any of that research before I shared it with you, because almost nobody knows it, as there are few with any strong motivation to make it public, and many motivated financially to keep it on the down-low.

    But as I said, you’ve clearly made up your mind, and I don’t think I’ll waste any more time talking to you about it. I’m always open to more evidence, but anyone who won’t even open a book that is chock full of scientific studies from one end to the other just because the author doesn’t meet his criteria of scientific purity is not someone whose opinion I can really respect a whole lot.

    But I do hope others whose minds are genuinely open will read the book. It’s converted some pretty conventional thinkers about psychiatry to some new views. It’s really not an antipsychiatry diatribe as you seem to fear. It simply asks a simple question: if psychiatric drugs are making lives better, why are so many more people on disability for mental health problems? I think it’s a damned good question myself.

    —- Steve

    Link to this
  76. 76. CurrentOutlook 7:07 am 06/25/2013

    portland17,

    “Nobody said anything about conspiracies.”

    Glad to read that, although you did introduce the proposition that “they” were cherry picking data. Ref here your post 71.

    “If you really think scientists are immune to this”

    Did I suggest so?

    “Claiming that the ADHD data is “off topic” appears to me to be an evasive maneuver of a person who has nowhere to hang his metaphorical hat.”

    Not at all. Dr. Lieberman’s study was not about the treatment of the ADHD, was it?

    “The “large body of evidence” you have provided seems mostly limited to a couple of studies on lithium”

    That means you have not read the evidence referenced by others in this thread, as the Lithium study was a long-term study, while the others were not about other treatments.

    As I have pointed out before, ADHD =/= Depression.

    “But as I said, you’ve clearly made up your mind”

    You remain mistaken about that.

    “I don’t think I’ll waste any more time talking to you about it.”

    We shall see.

    “It’s really not an antipsychiatry diatribe as you seem to fear.”

    Why should I fear it if it is correct? I do discount the fringe theories.

    “if psychiatric drugs are making lives better, why are so many more people on disability for mental health problems?”

    Because SSA now permits and pays for it.

    Link to this
  77. 77. CurrentOutlook 6:12 pm 06/25/2013

    Correction:

    “while the others were not about other treatments.”

    should read

    “while the others WERE about other treatments.

    Sorry about that.

    Link to this
  78. 78. Mersenne 10:18 pm 08/10/2013

    Thank you, Dr. Stone. I’m one of those former patients who was more harmed than helped by psychiatry. Four years ago, I was prescribed an antidepressant and got much worse. Long story short, more and more drugs were heaped on, until I was taking five different “meds” (a term I put in quotation marks as I find it both condescending and misleading). I felt like a zombie. I couldn’t work. What started out as a classic breakdown, the result of menopause and huge prolonged amounts of stress, turned into a plethora of labels that did nothing to help me. I was a disorder, not a person. Finally, I asked myself the questions nobody else did, the primary one being “why?” By myself, I went off the drugs, very slowly, and got better. The horrendous side effects abated, and now, two years later, have disappeared. I also quit my arrogant psychiatrist and found a therapist who treated me with respect. I made changes in my life. I’m now able to work. I got my life back despite of, not because of, psychiatry, and it’s time psychiatry listened to me and others with similar experiences.

    Link to this

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