The psychiatric drug crisis • Hacker News Board

Re: The psychiatric drug crisis

#131

Post by lutusp » Sun, Sep 08, 2013, 5:57 PM UTC

tokenadult wrote: post #124

lutusp wrote: post #100

Earlier quoted context omitted.

> What evidence does Gary Greenberg provide in his writings that would convince a skeptical onlooker that what he does for his patients is helpful? The same question could be asked of any psychologist, psychotherapist or psychiatrist, regardless of their publication record. There are no objective, scientific, rigorous evaluation criteria anywhere in the field, which explain why the mental health field has the reputat…

I think you are saying that we can't be sure that the author of the article kindly submitted here really knows what he is talking about. Diederik Stapel is a disgrace, http://retractionwatch.wordpress.com/2013/08/02/measure-by-m... but he also hasn't had any influence on the clinical practice of psychiatry in the United States, the main topic of the article.

> I think you are saying that we can't be sure that the author of the article kindly submitted here really knows what he is talking about.

That's true in all intellectual pursuits, and particularly true in science -- there are no truths, only evidence.

> ... but he also hasn't had any influence on the clinical practice of psychiatry in the United States, the main topic of the article.

He published in the same journals as U.S. researchers and therapists, working to the same standards (or lack thereof) and with the same contempt for science that is a hallmark of the field. It certainly does indict the entire field, or do you think Europe is located on a different planet?

Since you seem to think Holland is located on an alien moon, here's a similar recent scandal involving a Harvard professor:

http://chronicle.com/article/Marc-Hauser-Resigns-From/128296...

Quote: "Marc D. Hauser, the Harvard psychologist found responsible for eight counts of scientific misconduct by the university, has resigned ..."

In scientific fields, such misbehavior isn't tolerated, and exposures of this kind end careers (example Jan Hendrik Schön, http://en.wikipedia.org/wiki/Sch%C3%B6n_scandal). Hauser, on the other hand, is, in his own words, moving on, exploring "some exciting opportunities in the private sector" and that he had been involved in some "extremely interesting and rewarding work focusing on the educational needs of at-risk teenagers."

So this public fraud, this person who holds science and professional responsibility in contempt, is going to be allowed to treat at-risk teenagers? Only in psychology.

Re: The psychiatric drug crisis

#132

Post by lutusp » Sun, Sep 08, 2013, 6:11 PM UTC

dragonwriter wrote: post #128

lutusp wrote: post #125

Earlier quoted context omitted.

With one important difference -- when a medical procedure or substance is shown to be useless or dangerous, doctors stop using it or go to jail. By contrast, psychologists just carry on with business as usual -- for example, there are still therapists offering recovered memory therapy. If a medical drug were proven ineffective as anti-depression drugs have, doctors would have to stop prescribing it or be sued for mal…

> If a medical drug were proven ineffective as anti-depression drugs have, doctors would have to stop prescribing it or be sued for malpractice. Anti-depressive (and other psychiatric) drugs are a subset of "medical drugs". > You can't sue psychologists for malpractice, because there's no such thing as good psychological practice for comparison. You can, in fact, sue a psyschologist for malpractice [1], but a psychol…

> Anti-depressive (and other psychiatric) drugs are a subset of "medical drugs".

No, they are not. Medical drugs are prescribed by doctors to treat medical conditions, not psychological ones. There are some medical drugs that are prescribed off-label to treat mental conditions, but that's a shady practice (albeit a common one).

> You can, in fact, sue a psyschologist for malpractice ...

Yes, but you can't compare what he does to effective practices, because there aren't any. This is why such cases are so rare, and why malpractice insurance is nearly unheard of among psychiatrists and psychologists. Many psychologists and psychiatrists have ruined the lives of their clients but proved immune to prosecution -- for example, the psychiatrist who prescribed the drugs that killed Rebecca Riley was eventually allowed to continue practicing psychiatry, and was neither prosecuted or sued (Rebecca's father was convicted of first-degree murder, her mother of second-degree murder).

http://www.boston.com/news/local/breaking_news/2010/03/hold_...

Quote: "Shortly after Rebecca died, Kifuji had entered into a voluntary agreement with the board to halt her practice. But two years later, after a grand jury declined to indict her and the board conducted its own inquiry, the board last fall allowed her to return to practice. She is currently seeing patients at Tufts Medical Center."

> ... but a psychologist isn't going to be prescribing anti-depressants

True, unless by the term "psychologist" we mean anyone practicing clinical psychology, in the same way that a physicist practices physics -- a way of speaking that groups particle physicists and cosmologists together, two fields much less alike than psychiatry and clinical psychology.

Re: The psychiatric drug crisis

#133

Post by ubercore » Sun, Sep 08, 2013, 6:33 PM UTC

saber_taylor wrote: post #126

phren0logy wrote: post #115

Earlier quoted context omitted.

I'm a psychiatrist, and I disagree with much of your post. I see below you mentioned going to a psychiatry conference many times, but if it was with the same docs why did you expect a higher level of scientific discourse? It's true that there are crummy psychiatrists, but please don't throw the rest of us under a bus. At our patient conferences, not being to cite articles to back up your treatment plan would be consi…

> We cannot really objectively measure or test pain. http://en.wikipedia.org/wiki/Dolorimeter Perhaps you meant in the brain.

I think the point stands, since that test is reliant on a patient reporting a sensation of pain. In the same way, psychiatrists must rely on patients expression the emotional problem they're feeling.

Reading that wiki entry, it looks like any objective measurements that arose from dolorimeters are not in active use, because they weren't helpful.

Re: The psychiatric drug crisis

#134

Post by tsotha » Sun, Sep 08, 2013, 6:57 PM UTC

danmaz74 wrote: post #91

This article has its own very naive bias: Thinking that every phenomenon must have a "root cause" - ie, a simple cause-effect explanation - and that if you don't find the root cause, you can't control the phenomenon. Take for example serotonin reuptake inhibitors. It's not important to know if a deficiency in serotonin is the "cause" of depression. All we need to know is if increasing the levels of serotonin correlat…

From a drug designer's perspective, though, this is a problem. If you don't know why the current drugs work you're going to have a lot of trouble improving them.

Re: The psychiatric drug crisis

#135

Post by phren0logy » Sun, Sep 08, 2013, 7:05 PM UTC

saber_taylor wrote: post #126

phren0logy wrote: post #115

Earlier quoted context omitted.

I'm a psychiatrist, and I disagree with much of your post. I see below you mentioned going to a psychiatry conference many times, but if it was with the same docs why did you expect a higher level of scientific discourse? It's true that there are crummy psychiatrists, but please don't throw the rest of us under a bus. At our patient conferences, not being to cite articles to back up your treatment plan would be consi…

> We cannot really objectively measure or test pain. http://en.wikipedia.org/wiki/Dolorimeter Perhaps you meant in the brain.

This is a systematized way to elicit a subjective report. My original point stands; we cannot measure it objectively (if, indeed, there is even merit to such a concept).

Re: The psychiatric drug crisis

#136

Post by beagle3 » Sun, Sep 08, 2013, 7:27 PM UTC

phren0logy wrote: post #115

kyro wrote: post #23

Good riddance. Psychiatry by and large is a sham field. Physicians who practice it love seeing themselves as artists who are experts in identifying the subtleties of human behavior. That's their way of saying there's very little underlying science guiding their practice. Many of the diagnoses given are pulled out of thin air and made to justify a patient's admission, or to appease a patient's desire to feel as if the…

I'm a psychiatrist, and I disagree with much of your post. I see below you mentioned going to a psychiatry conference many times, but if it was with the same docs why did you expect a higher level of scientific discourse? It's true that there are crummy psychiatrists, but please don't throw the rest of us under a bus. At our patient conferences, not being to cite articles to back up your treatment plan would be consi…

There's a way to objectively measure subjective pain. At least, these guys[1] claimed to have done it, and i've been told by someone who examined them as part of investment due-diligence, that it actually works (better than the cartoon face scale, anyway)

[1] http://www.medasense.com/

Re: The psychiatric drug crisis

#137

Post by danmaz74 » Sun, Sep 08, 2013, 7:28 PM UTC

tsotha wrote: post #134

danmaz74 wrote: post #91

This article has its own very naive bias: Thinking that every phenomenon must have a "root cause" - ie, a simple cause-effect explanation - and that if you don't find the root cause, you can't control the phenomenon. Take for example serotonin reuptake inhibitors. It's not important to know if a deficiency in serotonin is the "cause" of depression. All we need to know is if increasing the levels of serotonin correlat…

From a drug designer's perspective, though, this is a problem. If you don't know why the current drugs work you're going to have a lot of trouble improving them.

Yes, but to know "why" (I'd much rather say "how") current drugs work you don't need to know "why" people get certain illnesses - that's my issue with the article.

Their logic is: low serotonin levels aren't the cause of depression - so raising serotonin levels will not eliminate the cause of depression - so doing that isn't useful. That's a naive (and wrong) logic. Your heart going into fibrillation is not the cause of your heart problems, but treating the fibrillation can save your life - whatever the "cause" of that fibrillation.

Re: The psychiatric drug crisis

#138

Post by Dylan16807 » Sun, Sep 08, 2013, 7:40 PM UTC

lutusp wrote: post #54

md224 wrote: post #26

Fun Fact: Selective Serotonin Reuptake Inhibitors, the class of drugs used to treat depression and anxiety disorders by increasing the availability of serotonin, have a mirror opposite: Tianeptine ( http://en.wikipedia.org/wiki/Tianeptine ), which acts as a Selective Serotonin Reuptake Enhancer. Incredibly, this drug has also been effective at treating depression . That's right: two classes of drugs with polar opposi…

> and both of them apparently work. I would have said they both appear to work. Recent findings cast doubt on that appearance (PDF warning): http://alphachoices.com/repository/assets/pdf/EmperorsNewDru...

Honest question, what's the difference between 'appear' and 'apparently' to you? As far as I use the words, one of their meanings is identical.

Re: The psychiatric drug crisis

#139

Post by snambi » Sun, Sep 08, 2013, 9:34 PM UTC

phren0logy wrote: post #115

kyro wrote: post #23

Good riddance. Psychiatry by and large is a sham field. Physicians who practice it love seeing themselves as artists who are experts in identifying the subtleties of human behavior. That's their way of saying there's very little underlying science guiding their practice. Many of the diagnoses given are pulled out of thin air and made to justify a patient's admission, or to appease a patient's desire to feel as if the…

I'm a psychiatrist, and I disagree with much of your post. I see below you mentioned going to a psychiatry conference many times, but if it was with the same docs why did you expect a higher level of scientific discourse? It's true that there are crummy psychiatrists, but please don't throw the rest of us under a bus. At our patient conferences, not being to cite articles to back up your treatment plan would be consi…

what is the basic fundamental in psychiatry? how a condition is diagnosed and treated?

Re: The psychiatric drug crisis

#140

Post by lutusp » Sun, Sep 08, 2013, 10:47 PM UTC

Dylan16807 wrote: post #138

lutusp wrote: post #54

Earlier quoted context omitted.

> and both of them apparently work. I would have said they both appear to work. Recent findings cast doubt on that appearance (PDF warning): http://alphachoices.com/repository/assets/pdf/EmperorsNewDru...

Honest question, what's the difference between 'appear' and 'apparently' to you? As far as I use the words, one of their meanings is identical.

> Honest question, what's the difference between 'appear' and 'apparently' to you?

They have similar etymologies, but their current meanings are diverging. An apparent difference may not be visual -- at least, not to the degree that an examination of the word's history would lead one to believe. An appearance of difference still is primarily visual.

And yes -- this is to some degree splitting hairs.