Diagnosis Present

9 04 2011

My previous post was quite rightly seen as an attack on psychiatry which was quite harsh and, if I’m honest, rambled a bit much (although that may have been due to the amount of alcohol fuelling the writing and dulling the sense of the same). So when queried about it, I began a reply which I then thought would be best curtailed and turned into a blog post instead. So here we go.In general I don’t have a problem with the practise of psychiatry, if I had a heart problem I wouldn’t be expecting my GP to perform open heart surgery unless his/her speciality was exactly that. So a specialist in psychiatric conditions is what is called for.

What I do have a problem with is psychiatrists in general. Ok, don’t get me wrong, there are some damn fine doctors out there who are a credit to their profession, and the older doctors, old enough to remember life before the magic bullets which truly founded psychiatry. These are the people who ask how the meds are working, who care about their patients, and who wouldn’t behave like a good proportion of psychiatrists do.

Unsurprisingly we have seen an explosion in the number of psychiatrists available, they currently outnumber psychologists in the UK on the NHS. So why do I have such a big problem with all of this? Surely having a large number of specialists is a good thing? Right, time to go through some points.

Psychiatry is NOT, and I’ve made that as big as I can without it getting silly, a science. Ok, so this point is not a big deal when you look at it as the practise of medicine is not a science as such, it’s the application of science. However, there seems to be a long standing move to psychopharmacology being the leading influence in this area and, to be fair, doctors can only go on what they know which means what the scientists tell them along with practical experience.

Psychopharmacology is NOT a science. Now we get a little more controversial. There are a few factors I’m basing this on rather than just going for a rant and if anyone wishes to correct me on this point then go for it.

There is a huge amount of research looking into the results of psychopharmacology yet when you look at the facts and figures it becomes evident that two things run through the vast majority of findings. One is that the numbers used are generally so small that even cosmetics companies who have to put the numbers to back their claims on their ads. Ever seen the small print on a L’Oreal advert? 73% of 42 people.

Hang on. So if one person agrees or disagrees, that’s over a 4% swing. You may be thinking this is no big deal but if you then consider that one or two people might be having a bad day then you get nigh on 9% swing right there (remember that one person switching means a two person difference rather than when one person drops out in case you were wondering about the maths involved). In science, you appreciate that there will be a variable involved which can throw up odd numbers from time to time, this is why you use big numbers so that the variable is minimised.

Next part is that the nominal difference between tested and placebo can be negligable, normally because the number of people tested were too small to make a difference. This results in the spin machine kicks in because the companies don’t want to use the tag line ‘May work a bit better than taking a sugar pill but you never know and to be fair, neither do we’. Yup, harsh but it’s not far off the truth is it.

Marketing of a product is done by showing the good side in the best possible light, whilst hiding the bad part in a locked cupboard somewhere hoping the FDA won’t notice. Makes sense from a business point but it’s not exactly science is it. However, this is what happens and we all know why that is don’t we kiddies. C’mon, you know where this is going, say it with me…

Money!

Yup, there it is. Money makes the world go round and pharmaceutical companies see this and try to make as much of it as they can. Can’t blame them really. How has this been evidenced? The good ol’ American Psychological Association waqs started as a body dedicated to scientific endeavours and so embarked on proving or disproving claims by the parmaceuticals. Did a sterling job of it too, proving what was a medicine and what was a load of junk marketed by scammers who knew if you used the word ‘tonic’ everyone would believe it was medicine. That is up till they saw how much money they could make.

Imagine the scene if you will, the APA on one side of the table, an unknown suit on the other. “We are the APA, we are steadfast in our task of science and knowledge” cue piece of paper being slid across the table from unknown suit to the speaker. “And we will never bow down bef… how much? Sir you insult me with your attempts at…” Cue finger of unknown suit pointing at a particular point on the piece of paper. “A year?!? Oh ummm, let me consult my colleagues”. Cue huddle of the APA with muffled sounds of “That’s not much” and “A year?!?!” followed by “Kerching!”. Naturally the APA would regroup and present their case for steadfast dedication to science and knowledge in the face of big money. “Of course, we of the APA, in our steadfast dedication to science and knowledge” going well so far “would see benefit from working with the producers in order to enrich the lives of all concerned” Doh!.

Yeah, I know, it probably didn’t happen like that but it certainly cuts out a lot of the drudgery involved, and I like it as a visual metaphor.

So whilst I’m not against meds, even if their creation was an accidental byproduct (like that’s never happened before… oh wait, no, it happens all the time), I am against the lack of science involved in getting at the truth of the matter. No, it’s not possible to do a true double blind test for psych meds, but it is possible to meta-analyse results and making sure ALL the results are published.

So doctors are being informed by possibly the most unreliable sources and expected to know what’s right. Some will be taking the incentives offered by mysterious benefactors, some won’t. Something which also clouds the mix. Science, and those who need the help, can and do suffer.

I’ve been trying not to swear in my blogs so ‘Oh flipping sugarplum fairies’. I’ve written a long post which derides the background of psychiatry and yet I’ve not actually done what I set out to do. Oh well, I’ll be damned (is that swearing?) if I’m junking it so thanks for reading and hopefully the next one will make a damn (swearing again or not?) bit more sense within the realms of what I was going to say.

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2 responses

12 04 2011
theurbanworrier

Can I just check you’ve read Goldacre’s Bad Science? You seem bang on message so it’s likely, but if you haven’t, you’d likely be delighted. (and although his CV is a bit obscured in favour of his journalistic escapades, an authoritative source -a Maudsley lecture, where he spoke that female sexual dysfunction is a myth- described him as having done the Maudsley round for psychiatrists. so when a psych dr says SSRIs are wrong, well, that’s good enough for me)

13 04 2011
nullfuture

Nope, never read it, never heard of the guy, so might be worth a look

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