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273 thoughts on “Angell’s Review of Psychiatry

  1. Geoff says:

    @nybgrus

    Your credentials are in no way, shape or form impressive to me. Please stop bring them up, because they are not relevant to the discussion. If you want to refute the anthropological data, do so based on the evidence, not based on your credentials. There is no reason for me to take you on your word that just because you studied medical anthropology and graduated with honors means that your opinion about the NUMEROUS studies by multiple anthropologists on multiple occasions and for multiple reasons holds any weight. I respect your intelligence enough to believe that you know better than to expect anyone, including myself, to take you at your word based on your credentials.

    Until you give me some credible evidence refuting the anthropological data that I am referring to, this will continue to be a point of contention, and we will have to agree to disagree. We can still debate other points, but it’s pretty unlikely that we will come to a consensus, particularly since it is such a foundational premise of my perspective.

    And no, the fact that cancer is a disease of old age does not mean that everyone gets it, but it should mean that as you get older, the proportion of deaths from cancer should increase, not decrease. Instead, we see the probability of death flatten out, to where the conditional probability of dying within the next 365 days is the same whether you are 102, 104, 109 or 115, and the probability that it is cancer that kills you is extremely low for all of these ages, much much lower than it is for someone who is in their 70s or 80s.

  2. weing says:

    “And no, the fact that cancer is a disease of old age does not mean that everyone gets it, but it should mean that as you get older, the proportion of deaths from cancer should increase, not decrease.”

    Why should it increase? In the death race, cardiovascular disease is the winner.

  3. nybgrus says:

    geoff:

    Your anthropological data has already been refuted by those of us here. Not just myself, but Dr. Hall as well (and even Micheleinmichigan and Chris, if I recall). I’m adding my credentials on top of that not as a substitute. Last time you came on here spouting your theories you actually gave us those citations. Dr. Hall and myself demonstrated why they were false. Now you don’t give citations anymore you just say “it’s my opinion, it’s anecdote.” I can counter your opinion with my much more informed and credible one. When you present an actual citation I can (and will… and have) counter that with actual evidence and science. Until you do, I’d say my opinion succesfully counters yours.

    As for your centenarian argument… again. I did not say “cancer is a disease of the OLDEST age” – if you are going to get cancer, you will likely get it by the time you are 70-80 years old. By then you will likely have survived most else of what will kill you and so if you haven’t gotten cancer by then AND you survive to be 100 you are in a selected group of people – namely those whose lifestyle didn’t kill them and whose genetics were not predisposed for cancer. That is why you still see it in that age group but the levels drop off and plateau to the normal background level.

    The fact that you can’t seem to understand that is further evidence that you aren’t studied enough in the topics your propose to be so convinced of.

    But the point is moot – I’ve already dispelled your WGA ideas and destroyed your theory in regards to ketogenic diets. You haven’t even been able to get past those and yet you still spout off anthropological data (which, once again, has already been refuted) as if that is somehow evidence.

    You even asked, “Well what if I was right about everything I said? What then?” And everyone roundly said that wouldn’t matter one whit – it would be pure luck, not science. Come back with something new if you want to get anything but the same from us here.

  4. daedalus2u says:

    Geoff, a perfect lifestyle can’t prevent a random cosmic ray from causing a DNA mutation that causes cancer.

    Mostly physiology is reactive. The reason exercise “works” to develop muscles and endurance is because you have exercised and exceeded the nominal capacity of those systems and caused over-use injury. The compensatory repair pathways then rebuild the damaged tissues with a little bit extra.

    You can’t have “perfect health” without activating those compensatory pathways and you can’t activate those compensatory pathways without causing damage first. It is the signals from the damaged tissues that activate the compensatory pathways.

    “Data” has a specific meaning. When you say “anthropological data”, that would be facts gathered by observations by anthropologists. There have been no observations of humans living 30,000 years ago that were recorded by anthropologists.

    The story related by the natives to Weston Price is not data about nutrition. It is data about traditional stories and traditional beliefs. The person who related the story to Weston Price could have been lying, could have been mistaken, could have been a quack trying to drum up business, or it could have been made up by the translator to show how indispensable the translator was. Or it could have been some unsubstantiated traditional belief, like the belief that GMOs are bad for you, or that organic food is better.

    Did the natives who claimed that animal matter had to be eaten every 3 months or they would die actually test that hypothesis? To do so would have been unethical for what ever native did it. It may be just like the old wives tale that if you go swimming sooner than an hour after eating you will get cramps and drown.

    Traditional stories about what can and cannot be eaten on what schedule is not data about nutrition. What about Native Americans who traditionally smoked tobacco, or chewed coca or ate peyote? Are those perfectly healthy practices? They must be according to your standards. How come the diseases of Europe brought over by the Spanish and English (smallpox, measles and so on) decimated that perfectly healthy population?

    There are traditional ideas about disease causation. It is hard to imagine how ancient people could have had a conceptualization of what disease was since they were in perfect health. Strange that they would go to the trouble of making up stories of such things to blame witches and demons for causes the diseases they didn’t have.

  5. Becky Murphy says:

    @Harriet

    You state, “because depression (perhaps of lesser severity) will respond to psychosocial interventions while schizophrenia does not.”

    There is work being done in Finland with first episode psychosis which contradicts your assertion:

    http://onlinelibrary.wiley.com/doi/10.1111/j.1751-7893.2009.00114.x/full

    http://www.dialogosproductivos.net/upload/publications/02022011154150.pdf
    these two are the same
    http://onlinelibrary.wiley.com/doi/10.1111/j.1467-6427.2008.00439.x/full

    http://onlinelibrary.wiley.com/doi/10.1111/j.1467-6427.2008.00439.x/full

    I share this not to argue, but to point out that biologically based treatments are not the only thing which have been used to treat schizophrenia, successfully: — “In a 5-year follow-up study of the Open Dialog intervention, 82% did not show any residual psychiatric symptoms and 86% had returned to school or work (Seikkula et al., 2006). Further, the relapse rates were very low, 17% in the first 2 years and 19% in the second 3 years.”

    And finally I will include a letter to the editor published in the Journal of Psychotherapy by William F. Northy Jr. of N-P therapeutic Services from which the above quote was taken:

    Dear Drs. Trepper and MacFarlane:
    I am writing in response to an article published in the October–December issue of the Journal of Family Psychotherapy by William Nichols entitled “Family Therapy and Serious Mental Disorders: A Retrospective and Prospective View.” I was very intrigued when I read that Nichols (2009) was going to “describe family therapy’s role in the treatment of serious mental disorders at the start of my career and today” (p. 344). The idea that Dr. Nichols was going to provide a historical context in which to understand the role that family therapy has played in helping people and families who suffer from serious mental illness was very exciting given that I have spent the last 5 years working with agencies and families dealing with such disorders. I commend Dr. Nichols, and you by extension, for embracing such an undertaking and providing a synopsis of the issues relative to family therapy and serious mental illness.
    The reason for my letter is not because of what was written in the article, for I concur with both the historical perspective and the continuing issues identified. However, my concern is with the absence of some significant historic changes of the last 10 years that directly impact the way that family therapists will deliver services to people with serious mental illness. These changes, which I describe briefly here, will not only influence the delivery of behavioral health services but will also shape the way that future family therapists are trained.
    A MILLENNIAL SHIFT
    Jump to section
    A MILLENNIAL SHIFT
    RECOVERY AND THE CONSUMER MOVEMENT
    RECOVERY AND FAMILY THERAPY
    Beginning at the end of the last millennium there was a monumental shift in the way that people who receive mental health services in the United States were viewed at both the national and local levels in the United States. Beginning with the Surgeon General’s Report on Mental Health (U.S. Department of Health and Human Services, 1999) and the first White House Conference on Mental Health in 1999 there was a paradigmatic shift occurring in the U.S. behavioral health system. As Nichols (2009) points out, part of this shift included an increased focus on evidence-based practices and an increased focus on the role that families play, but this shift also included a closer inspection of the way behavioral health services are delivered, particularly the role that “consumers” play in their own “recovery.” I take up recovery more later, but I would be remiss if I did not point out some of the other noteworthy activities that occurred in the 2000s.
    As a direct result of the White House Conference on Mental Health and the Surgeon General’s report, President Bush, in the spring of 2002, appointed the New Freedom Commission on Mental Health. The charge of this commission was to conduct a comprehensive study of the mental health service delivery system and to make recommendations for improving the system (New Freedom Commission on Mental Health, 2003). The commission identified six goals to change the mental health system and developed recommendations for each. The six goals were:
    Americans understand that mental health is essential to overall health
    Mental health care is consumer and family driven
    Disparities in mental health services are eliminated
    Early mental health screening, assessment, and referral to services are common practice
    Excellent mental health care is delivered and research is accelerated
    Technology is used to access mental health care and information
    Concurrently, the Institute of Medicine (IOM) was just completing its landmark report on the nation’s health system with the publication of Crossing the Quality Chasm: A New Health System for the 21st Century (2001). The IOM report, while not specifically focused on the behavioral health system, reverberated throughout it. In fact, a subsequent report, Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders, was commissioned by the Substance Abuse and Mental Health Services Administration (SAMHSA) and released in 2005. Similar to its predecessor, the adaptation for behavioral health focused on making health care safer, effective, patient-centered, timely, efficient, and equitable. The other contemporaneous event of note was the creation of the Annapolis Coalition on Behavioral Health Workforce (http://www.annapoliscoalition.org), which brought together the behavioral health professional organizations (e.g., AAMFT, APA, NASW, ACA) to address concerns regarding how to best embark on the workforce needs and its deficits in behavioral health care. The Annapolis Coalition sponsored two conferences (one focused on development of competencies among the behavioral health professions) and produced a number of publications (e.g., Hoge & Morris, 2002, 2004; Hoge, Morris, & Paris, 2005; Hoge, Paris et al., 2005).
    Concomitantly, the AAMFT formed the core competences task force, which was charged with developing the MFT Core Competencies (AAMFT, 2004; Nelson et al., 2007; Northey, 2005) and was directly influenced by the national and international activities that focused on the challenges facing people and families with behavioral health problems. Specifically, there are a number of core competencies (e.g., 1.1.3. Understand the behavioral health care delivery system, its impact on the services provided, and the barriers and disparities in the system; 2.1.3. Understand the clinical needs and implications of persons with comorbid disorders; 3.1.4. Understand recovery-oriented behavioral health services; 4.3.9. Provide psychoeducation to families whose members have serious mental illness or other disorders) that speak directly to working effectively with people with a serious mental illness.
    RECOVERY AND THE CONSUMER MOVEMENT
    Jump to section
    A MILLENNIAL SHIFT
    RECOVERY AND THE CONSUMER MOVEMENT
    RECOVERY AND FAMILY THERAPY
    One of the most dramatic shifts in the last 10 years has been the focus on recovery, which is the belief that people who are dealing with mental illness should be “in charge” of the strategy or plan for dealing with their behavioral health conditions. While recovery was initially a concept used by people dealing with substance misuse problems, the concept has been embraced by people who suffer from mental health problems. SAMHSA (n.d.) defines recovery as “a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.” Further, there are 10 fundamental components to recovery: self-direction, individualized and person centered, empowerment, holistic, nonlinear, strengths-based, peer support, respect, responsibility, and hope. It is beyond the scope of this letter to go into great detail about the specifics and history of the recovery movement (cf. Copeland, 2000; Hopper, Harrison, Janca, & Sartorius, 2007; Gehart, in press[a]; Ralph, 2000; Sheedy & Whitter, 2009), suffice it say that it is not only a major focus of the federal government in the United States but very much consistent with many family therapy models and practitioners (see Gehart, in press[b]; Mueser & Gingerich, 2006).
    RECOVERY AND FAMILY THERAPY
    Jump to section
    A MILLENNIAL SHIFT
    RECOVERY AND THE CONSUMER MOVEMENT
    RECOVERY AND FAMILY THERAPY
    The State of California has long been a bellwether, and with more than half of all licensed marriage and family therapists (MFTs) residing in California it has the potential to be extremely influential in the direction of the field. In 2010, the Board of Behavioral Science, which regulates MFTs in California, modified the licensure regulation to specifically include education and experience focused on recovery. The new regulations require that family therapy training programs include “The principles of mental health recovery-oriented care and methods of service delivery in recovery-oriented practice environments, among others”; “Provide students with the opportunity to meet with various consumers and family members of consumers of mental health services to enhance understanding of their experience of mental illness, treatment, and recovery”; and “Learning about current programs of recovery, such as 12 step programs, and how therapists can effectively utilize these programs” (Board of Behavioral Sciences, 2010). This seeming radical change from the regulations that have been promulgated in other states, and by other national family therapy organizations, is unprecedented and highlights the recognition that people with behavioral health problems are active consumers of behavioral health services.
    I appreciated that Nichols (2009) referenced the tremendous work on family psychoeducation (FPE) that has been pioneered by McFarlane and his colleagues (McFarlane, Dixon, Lukens, & Lukstead, 2003). Despite the strong empirical support for FPE it is estimated that less that 10% of family actually get the intervention. Although the specific reason is not clear, the barriers are numerous, but access to competent clinicians, trainers, and supervisors is clearly one such barrier. There are a number of roles that MFTs can play in the mental health system, but negotiating those systems is difficult and not often the focus in family therapy training programs (Epstein & Northey, 2007). Not only are MFTs uniquely qualified to provide FPE but they could also enhance the delivery of FPE services by becoming trainers and supervisors.
    Another underutilized intervention is that developed by Seikkula and his colleagues (Seikkula, 2008; Seikkula, Alakare, & Aaltonen, 2009; Seikkula, Arnkil, & Eriksson, 2003), which has had a significant impact on the delivery of services in Finland and has shown significant reduction in symptomology, hospitalization, and disability (Seikkula, 2010). Further, participants in the “Open Dialog” process were more likely to be employed or in school and less likely to be on psychotropic medications. In a 5-year follow-up study of the Open Dialog intervention, 82% did not show any residual psychiatric symptoms and 86% had returned to school or work (Seikkula et al., 2006). Further, the relapse rates were very low, 17% in the first 2 years and 19% in the second 3 years.
    For me, the Nichols article points out how the role that family therapists play is on the precipice of coming full circle. The early pioneers of family therapy were very engaged in working with people with serious mental illness. The myriad changes that have occurred in the last 60 years has dramatically changed the behavioral health landscape and the complexity of systems and the cooccurring problems (e.g., homelessness, chronic medical conditions, substance misuse) have once again necessitated behavioral health professionals who understand how to negotiate and intervene in complex systems. Family therapists are exceptionally qualified to assist in the navigation of the increasingly complex systems of care, and this critically important work is fundamental to our ideology that regardless of the problems individuals and families experience their strengths and resources can and should marshaled to mitigate the effects of behavioral health problems.
    William F. Northey, Jr.
    N-P Consulting & Therapeutic Services
    Wilmington, Delaware, USA
    REFERENCES
    1. American Association for Marriage and Family Therapy. 2004. Final report of the MFT Core Competencies Task Force, Washington, DC: Author.
    2. Board of Behavioral Sciences. (2010) Statutes and regulations relating to the practice of: Professional clinical counseling marriage and family therapy educational psychology clinical social work. Retrieved from http://www.bbs.ca.gov/pdf/publications/lawsregs.pdf (http://www.bbs.ca.gov/pdf/publications/lawsregs.pdf)
    3. Copeland, M. E. 2000. Wellness recovery action plan (Rev. ed), West Dummerson, VT: Peach Press.
    4. Epstein, N. E. and Northey, W. F. Jr. MFTs’ roles in healing families with serious mental illness. The 65th Annual Conference of the American Association for Marriage and Family Therapy. Long Beach, CA. October.
    5. Gehart, D. in press[a]. The mental health recovery movement and family therapy, part I: Consumer-lead reform of services to persons diagnosed with severe mental illness. Journal of Marital and Family Therapy.,
    6. Gehart, D. in press[b]. The mental health recovery movement and family therapy, part II: A Collaborative, appreciative approach for supporting mental health recovery. Journal of Marital and Family Therapy.,
    7. Hoge, M. A. and Morris, J. A., eds. 2002. “Behavioral health workforce education and training [Special issue]”. In Administration and Policy in Mental Health Vol. 29(4/5),
    8. Hoge, M. A. and Morris, J. A., eds. 2004. “Implementing best practices in behavioral health workforce education—Building a change agenda [Special issue]”. In Administration and Policy in Mental Health Vol. 32(2),
    9. Hoge, M. A., Morris, J. A. and Paris, M., eds. 2005. “Workforce competencies in behavioral health [Special issue]”. In Administration & Policy in Mental Health Vol. 32(5),
    10. Hoge, M. A., Paris, M., Adger, H., Collins, F. L., Finn, C. V.Fricks, L. 2005. Workforce competencies in behavioral health: An overview. Administration and Policy in Mental Health, 32: 489–527. [CrossRef], [PubMed]
    11. Hopper, K., Harrison, G., Janca, A. and Sartorius, N., eds. 2007. Recovery from schizophrenia: An international perspective: A report from the WHO Collaborative Project, the international study of schizophrenia, Oxford, , UK: Oxford University Press.
    12. Institute of Medicine. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century, Washington, DC: National Academy Press.
    13. Institute of Medicine. 2006. Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders, Washington, DC: National Academy Press.
    14. McFarlane, W. R., Dixon, L., Lukens and Lukstead, E. 2003. Family psychoeducation and schizophrenia: A review of the literature. Journal of Marital and Family Therapy, 29: 223–245. [CrossRef], [PubMed], [Web of Science ®], [CSA]
    15. Mueser, K. T. and Gingerich, S. 2006. The complete family guide to schizophrenia: Helping your loved one get the most out of life, New York, NY: Guilford Press.
    16. Nelson, T. S., Chenail, R. J., Alexander, J. F., Crane, D. R., Johnson, S. M. and Schwallie, L. 2007. The development of core competencies for the practice of marriage and family therapy. Journal of Marital and Family Therapy, 33: 417–438. [CrossRef], [PubMed], [Web of Science ®]
    17. Nelson, N. S., Chenail, R. J., Alexander, J. F., Crane, D. R., Johnson, S. M. and Schwallie, L. 2007. The development of core competencies for the practice of marriage and family therapy. Journal of Marital and Family Therapy, 33: 417–438. [CrossRef], [PubMed], [Web of Science ®]
    18. New Freedom Commission on Mental Health. 2003. Achieving the promise: Transforming mental health care in America. Final report (DHHS Publication No. SMA-03–3832), Rockville, MD: DHHS.
    19. Nichols, W. C. 2009. Family therapy and serious mental disorders: A retrospective and prospective view. Journal of Family Psychotherapy, 20: 344–359. [Taylor & Francis Online]
    20. Northey, W. F. Jr. 2005. Are you competent to practice marriage and family therapy core competencies. Family Therapy Magazine, 4: 10–13.
    21. Ralph, R. O. (2000). Review of recovery literature: A synthesis of a sample of recovery literature 2000. National Association for State Mental Health Program Directors. Retrieved from http://www.nasmhpd.org/general_files/publications/ntac_pubs/reports/ralphrecovweb.pdf (http://www.nasmhpd.org/general_files/publications/ntac_pubs/reports/ralphrecovweb.pdf)
    22. Substance Abuse and Mental Health Services Administration (SAMHSA). (n.d.). National consensus statement on mental health recovery. Retrieved from http://mentalhealth.samhsa.gov/publications/allpubs/sma05-4129/ (http://mentalhealth.samhsa.gov/publications/allpubs/sma05-4129/)
    23. Seikkula, J. 2008. Inner and outer voices in the present moment of family and network therapy. Journal of Family Therapy, 30: 478–491. [CrossRef], [Web of Science ®]
    24. Seikkula, J. Open dialogues in western Lapland: Clients voices as resources. The International Family Therapy Association’s 18th World Family Therapy Congress. Buenos Aires, Argentina. March.
    25. Seikkula, J., Aaltonen, J., Alakare, B., Haarakangas, K., Keranen, J. and Lehtinen, K. 2006. Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies. Psychotherapy Research, 16: 214–228. [Taylor & Francis Online], [Web of Science ®]
    26. Seikkula, J., Alakare, B. and Aaltonen, J. 2009. Open dialogue in psychosis II: A comparison of good and poor outcome cases. Journal of Constructivist Psychology, 14: 267–284.
    27. Seikkula, J., Arnkil, T. E. and Eriksson, E. 2003. Postmodern society and social networks: Open and anticipation dialogues in network meetings. Family Process, 42: 185–203. [CrossRef], [PubMed], [Web of Science ®], [CSA]
    28. Sheedy, C. K. and Whitter, M. 2009. Guiding principles and elements of recovery-oriented systems of care: What do we know from the research? (HHS Publication No. [SMA] 09–4439), Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration.
    29. U.S. Department of Health and Human Services. 1999. Mental health: A report of the surgeon general—Executive summary, Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

  6. Geoff says:

    @nybgrus

    No, you have not refuted any anthropological data. You and Dr. Hall both have said that Weston Price is not a reliable source, but this is not a refutation. Using Weston Price’s anthropological data as a foundation of a nutritional framework has resulted in positive n=1 changes in many individuals, changes that I have witnessed first hand. So while I have no way of knowing whether the data is real or not, the fact that I have seen it work, which goes against the grain of the current understanding of nutrition and disease in the medical community, is a powerful data point. To you it is not, because you haven’t witnessed it with your own two eyes, but to me it is. And if you had seen these changes with your own two eyes, it would be for you too, because the changes are too dramatic and consistent to be as a result of chance.

    This centenarian thing is starting to piss me off, because it is completely strawman, and anyone who understands randomness and the law of large numbers should be able to make this logical leap with me without me having to spell it out. Clearly that is not the case, so let me elaborate:

    You are saying that cancer is not preventable. It is as a result of a genetic mutation that is uncommon but occurs at a fixed or increasing-with-age rate. You are saying that it is a “disease of old age,” which when taken with the genetic mutation thing, to me means that the probability of getting cancer is either the same no matter what age you are; and thus living longer increases the likelihood that you will get cancer by the law of large numbers; or increases as your body gets older, which should show an even greater increase in the incidence of cancer as one gets older, and still has no reason to drop off after a certain age.

    Citing survivor bias is, in and of itself, a direct refutation of every element of this hypothesis. Saying that the fact that you have survived through your 80s makes you less likely to get cancer under your model is the logical equivalent of saying that the fact that the roulette wheel has hit black 20 times in a row means that the probability that it will hit red on the next role or at all in the next 10 roles is very small, rather than the same no matter what any of the previous roles are, since the events are independent.

    You cannot have this both ways. If someone can be significantly less susceptible to cancer than someone else, that means that cancer is about much more than the correct series of random genetic mutations lining up. It means that something about those people’s bodies is different. Rather than just throwing your hands in the air and saying, “well, cancer is a disease of old age, it’s not preventable, so let’s figure out how to fix it rather than trying to prevent it,” you should be saying, “maybe my model of cancer is wrong, maybe something else is going on. Maybe, just maybe, something about the metabolism has an influence on the growth of cancerous mutations. What does, how does it, and how can I use this knowledge to my advantage?”

    Trying to cure cancer is a necessary part of medical science. That said, trying to prevent cancer is a much more interesting question, and one that is relevant to many more lives. The fact that you are taking it on faith that there is a subset of cancers that are totally unpreventable is decidedly unskeptical. I am not saying you have to agree with the means by which I am suggesting you go about preventing it, but I am saying that giving up on prevention is going to roadblock you from ever figuring out what is.

  7. Geoff says:

    @daedalus2u

    I not saying that the damage is not happening. I am saying that in a healthy individual, the damage gets healed without it effecting the organism.

    You are also reading much more into what I am saying constitutes the “anthropological data.” I am saying that his observations of life expectancy, disease prevalence, straightness of teeth, general fitness, etc. are valid. The stories that the natives assign do not have to be true for their results to be true. If he was the only one who ever observed this,

    I would be more suspect of the data, but as it stands now, it has been observed by many people independently of each other. The Inuit, as an example, were first studied by Vilhjalmur Stefansson first. He lived with them for two years, and wrote an extensive account of their lifestyle and disease susceptibility. Weston Price studied them again, independently, and came to very similar conclusions. The same can be said for many other traditional cultures, which again is why I am willing to accept the data as given unless I am given better evidence refuting it.

  8. Geoff says:

    Blah, so many typos. Still readable, I hope.

  9. woo-fu says:

    @Becky Murphy

    when the victim has a psychiatric diagnosis, crimes against them are seldom, if ever investigated

    Unfortunately, a psychiatric diagnosis still carries unwarranted stigma. Examples of injustice against individuals in such situations abound. This can and has been a major problem for individuals who need other types of medical care, too. Sometimes it’s just easier to assume everything relates to a psychiatric state than to dig deeper into complex biological processes.

    On the flip side, in our state we have wardens wishing more inmates had access to mental health care because they feel these people would not be institutionalized at all with proper treatment.

    Thanks for clarifying your story. I misinterpreted, thinking your son was still a child. I can understand why you cannot trust the mental health field, given the circumstances you all went through. It isn’t like that everywhere, though. I know this personally, and I have experience with trauma and PTSD. However, continuing to advocate for human rights in this field is a definite necessity. There is much room for growth and reform.

    You stated that your son’s agoraphobia has worsened from his experiences, and I imagine he has little interest in support systems from the mental health community at this point. So I’d like to point out that veterans who have experience with PTSD might be a good source for him. Most veterans I’ve met are more than happy to help others reach a better quality of life; some will even do home visits with therapy dogs.

    If he has adequate support systems currently, that’s great, but if not, maybe this is an approach he could consider. I wish you both the best.

  10. WilliamLawrenceUtridge says:

    Geoff:

    The difference between a hunter-gatherer and a person living in the world extends to far, far more than just diet. Hunter gatherers lived longer than the first farmers and were often healthier (because epidemic diseases are much greater problems in cities as well as having a broader diet) but they also got much more, and a different type of exercise. You can’t just assume hunter-gatherer health is solely determined by diet since they also have to work their asses off to get their food. If nothing else, the fact that an Inuit living a traditional lifestyle expends thousands more calories a day than their modern-living cousin who lives in a house and shops means your comparisons about diet are pretty much worthless. The thing is, wheat and sugar are things that accompany modern lifestyle, which is enormously different from any traditional one. You’d have to run a study which controlled for lifestyle if nothing else. If you’re talking purely about cancer, then the biggest difference will surely be longevity – hunter-gatherers die later than neolithic, bronze and iron-age farmers for a variety of reasons, but still several decades earlier than the average North American. Chances are they die with cancer rather than from it.

    As for diet’s role in cancer prevention overall – there was a study examining this last year and the results weren’t that good, suggesting that a diet high in fruits and vegetables is most, possibly only, chemoprotective in early life. Unlike smoking, where cancer risk drops after a lifestyle change, it may be relatively stable once you reach adulthood.

    As for toxins in plants, yes they produce toxins to attempt to prevent animals from eating them. Sometimes successfully, sometimes not. But do you know what we call those toxins? Herbs and spices. For one thing, the toxins are not just aimed at animals but also insects. We eat a mint leaf and experience a pleasant tingling coolness because it’s dilution relative to our body mass is considerable, but a bug eats it and dies. Nature isn’t built around humans, we’re just one part of the ecosystem. For another thing, plants will actively use those toxins to spread their seeds – an animal eats a mildly toxic fruit or seed, then disperses the result in a pile of dung far from the parent. For a third thing, humans cook and otherwise prepare plants for the express purpose of detoxifying them such as inactivating proteins with heat and soaking them out in water. For a fourth thing, most of the plants you are citing (really most that humans eat) are strongly bred by humans expressly for consumption and bear almost no resemblance to wild counterparts. “Original” wheat doesn’t look very much like the many different varieties we use to make bread (the variety is known as einkorn wheat and it’s used to make a type of porridge in Switzerland I believe; also note that it’s apparently less toxic than its wild counterpart to those with coeliac disease). Wild peas explode out of their pods, while cultivated varieties do not, so we can eat them.

    Anyway, a hunter-gatherer diet would be hard to maintain for a variety of reasons:
    - humans are concentrated, wild sources of food are widely dispersed, so if a sizeable portion of the population decided to adopt it, starvation or massive destruction of the natural environment would ensue
    - a local diet would be incredibly bland; the food may be nutritious but it’s strongly limited by time of year, location and simple availability
    - wild sources of food are extremely calorie-poor, the ones we subsist on in modern times were bred to be larger and richer in macronutrients
    - unless you’re willing to live in the wild, you’re likely to be far from sources of food

    Claiming switching to a paleodiet would be a miracle also ignores, if nothing else, the fact that most of the people living today descend from populations who did not live on a paleodiet.

  11. Harriet Hall says:

    @Geoff,

    If the evolutionary diet/lifestyle supports “perfect health” and prevents all chronic diseases, what did our ancestors die of?

  12. Harriet Hall says:

    @Geoff,
    “you have not refuted any anthropological data”

    You have not provided any credible anthropological data to refute. The personal observations of an ideologue dentist and an Arctic explorer are not acceptable scientific evidence. People see what they are looking for. The observations you cite were not collected with scientific rigor, properly published and submitted to peer review in the usual scientific process, or replicated. They amount to the kind of anecdotal evidence that can direct research, not to the kind of evidence you can rely on for dietary guidance.

  13. Harriet Hall says:

    @ Geoff,

    “The fact that you are taking it on faith that there is a subset of cancers that are totally unpreventable is decidedly unskeptical.”

    No one is taking that on faith. There is a known mechanism of cancer development that makes it highly unlikely that all cancers can be prevented. I wouldn’t say it’s absolutely impossible, but so extremely unlikely that it might as well be impossible. Science tells us that the processes of cancer are the same processes that govern aging, regeneration, healing, and reproduction.

    Please read “The Emperor of all Maladies” before you say another word about cancer.

  14. DW says:

    Geoff:
    “if you had seen these changes with your own two eyes, it would be for you too, because the changes are too dramatic and consistent to be as a result of chance.”

    Geoff, this is a very basic fallacy. I suggest you learn how scientists actually study things, what counts as evidence, etc. You don’t have a foundation in these things at even the most basic level to be trying to dispute scientifically with qualified people. You need at the very least a Statistics 101 course.

    In short, people see lots of things with “our own two eyes” that turn out not to be true, or that turn out to have causes we did not suspect (not the least of which is self-delusion and the power of suggestion). Science takes this phenomeon into account and attempts to control for the ubiquity of such mistaken beliefs – not assume them as a working basis, as you do.

  15. Harriet Hall says:

    @Geoff,

    DW is right. I saw a magician saw a woman in half, repeatedly. I might assert that he had really cut her in half and reunited the halves. But there are other explanations for what I saw with my own eyes. The improvements you observed could have been due to the evolutionary diet, or they could have been due to factors other than the evolutionary diet, or they could have been due to some part of the diet rather than the whole. Only scientific testing can determine which explanation is correct.

    You place a great deal of reliance on your personal powers of observation and reasoning. Your confidence is misplaced. Even the most “obvious” ideas must be tested by science and are often found lacking.

  16. Harriet Hall says:

    @Becky Murphy,

    “depression (perhaps of lesser severity) will respond to psychosocial interventions while schizophrenia does not.”

    Those were William Hoffman’s words, not mine, but I agree with him. They reflect the common understanding of psychiatrists, and I think the statement is true in general. That doesn’t mean that psychosocial interventions are not helpful and do not deserve an expanded role.

  17. Becky Murphy says:

    Harriet,

    All due respect to William Hoffman, and to your agreeing with him–”common understanding” is NOT derived from the Scientific Data Base now is it? It is in fact basically, psychiatric folk lore, and lacks understanding, of the individuals labeled as having schizophrenia themselves; IMHO. This “common understanding” and “Practice Parameters” are both the result of a consensus of subjective opinions of a relative few of the APA membership–virtually all of whom have major Conflicts of Interest–and are based on subjective opinions—the weakest type of “scientific evidence”– which in any other field of science is NOT enough to be definitive, without a Scientific Evidence Base to support these “common understanding” and “Standard Practices.”

    I have a low opinion of most–not all–psychiatrists because of the serious lack of efficacy in the treatments that in this country are given under Force using Court Orders, or without disclosing risks and potential benefits in a straightforward and honest manner; the fact that coercion, manipulation, and subterfuge are tools used more commonly than not—In my community I have three friends my age who are physically and cy impaired by the neuroleptic drugs none of whom were told it was even a potential risk—one is in fact now wheelchair bound–and she was not even diagnosed with schizophrenia—but the neuroleptics are now used for symptoms of other psychiatric diagnoses. Truly Horrifying. I have a friend whose granddaughter was given neuroleptics at the age of nine and her now 14 y/o granddaughter has gained 100 lbs. has high cholesterol and high blood pressure, and has akathesia and is showing signs of aggression—all known potential risks with neuroleptics—NONE of these risks were shared with her, or the child—–NO Informed Consent, which is really how psychiatry is most often done to people instead of honestly discussing what is and is not known about the diagnoses themselves and the drugs used to treat the symptoms experienced—

    This is typical, and neuroleptics do not have an Evidence Base which would lead a reasonable person to conclude these terotogenic drugs are or should be the First Line treatment for schizophrenia—so why is it these drugs are being used for an ever expanding number of psychiatric diagnoses, or more accurately, more and more symptoms of distress, regardless of the psychiatric diagnosis? It is psychiatrists that are behind this.

    Charles Whitfield’s work is also notable, and I have written about it. http://involuntarytransformation.blogspot.com/2011/01/can-trauma-be-cause-of-mental-illness.html

    http://nhne-pulse.org/wp-content/uploads/2010/12/Psychiatric_Drugs_As_Agents_of_Trauma_JRS508.pdf

  18. Becky Murphy says:

    @woo-foo

    Thank you for your suggestion about reaching out to veterans as a potential support for my son.

  19. Harriet Hall says:

    @Becky,
    “”common understanding” is NOT derived from the Scientific Data Base now is it?”

    I meant a common understanding of the currently available scientific evidence. Despite their many drawbacks, drugs are effective in controlling the symptoms of schizophrenia, and the evidence that psychosocial treatments can offer similar or superior outcomes is limited and controversial.

  20. Nescio says:

    This thread reminded me that schizophrenia was once treated with hemodialysis, based on the hypothesis that it is caused by the accumulation of some sort of toxic substance. There’s quite a bit on PubMed about this, for example http://www.ncbi.nlm.nih.gov/pubmed/6625961 . It seems it was abandoned when double blind placebo controlled clinical trials found no benefit. http://www.ncbi.nlm.nih.gov/pubmed/6625966

    I think it’s interesting that an elaborate placebo apparently had such a large effect on schizophrenia.

  21. nybgrus says:

    @Geoff:

    As the others have said, your basic understanding of the scientific process, scientific inquiry, oncogenesis, and logical fallacy are extremely poor.

    The anthropological data I referred to was the last time you came on here with your ketogenic diet ideas and cancer prevention ideas. You have since offered nothing but anecdote and “just-so” stories – in other words, you have offered nothing.

    I know Dr. Hall addressed this but it is so blatantly erroneous of you I have to address it as well:

    “The fact that you are taking it on faith that there is a subset of cancers that are totally unpreventable is decidedly unskeptical.”

    I am not taking anything on faith. I, very much unlike you, actually have a pretty decent grasp of oncogenesis. Not likely as good as Dr. Hall, and most certainly not as good as Dr. Gorski, but vastly better than yours by a long shot. It is from this knowledge that I can say there are a subset (probably a very large portion) that are currently completely unpreventable. Eventually, we may have incredibly advanced molecular and nano tech that can prevent all cancers – I think that is within the realm of reality, just not in our lifetimes.

    This brings us back to the centenarian argument. Of course you are frustrated, because you can’t seem to grasp the very basics of oncogenesis that are necessary to understand the issue.

    You are saying that it is a “disease of old age,” which when taken with the genetic mutation thing, to me means that the probability of getting cancer is either the same no matter what age you are; and thus living longer increases the likelihood that you will get cancer by the law of large numbers; or increases as your body gets older, which should show an even greater increase in the incidence of cancer as one gets older, and still has no reason to drop off after a certain age.

    You are correct right up till the last clause. You are making the assumption that the only mechanism for oncogenesis is random mutation and repair defects. No, that would be the baseline minumum level of oncogenesis – which is why centenarians still get cancer. There are a pile of other things that make it more likely to get cancer than just the baseline level. Inherited oncogenic mutations (like BRCA1/BRCA2) for example. Or inherited and intrinsic differences in the fidelity of DNA repair mechanisms. And environmental factors like sun, smoking, carcinogen exposure, etc. All of these things add up to produce cancer and the likelihood of them coming together to form a neoplasm increases with age (the law of large numbers). It would seem that tends to peak around the 6th-8th decades of life. Those people get cancer and die. Now, who is left over? The people without the inherited oncogenic mutations, with better fidelity in DNA repair mechanisms, without carcinogenic exposure, or environmental exposures. In other words, people who will only be susceptible to the baseline level of oncogenesis, thus their cancer rates would be lower than those who died in their 70s and 80s as a result of cancer.

    You even seem to almost get it when you say:

    You cannot have this both ways. If someone can be significantly less susceptible to cancer than someone else, that means that cancer is about much more than the correct series of random genetic mutations lining up. It means that something about those people’s bodies is different.

    The problem is, I can have it “both ways” because it isn’t one or the other, it is a combination of many factors. There are cases where someone is significantly less susceptible to cancer, but mostly the data driving your misconceptions about the octogenerian vs centenarian problem is that most people are significantly more susceptible and they die off, leaving the less susceptible group to live to be 100.

    But then you go off the rails again:

    …is about much more than the correct series of random genetic mutations lining up. It means that something about those people’s bodies is different. Rather than just throwing your hands in the air and saying, “well, cancer is a disease of old age, it’s not preventable, so let’s figure out how to fix it rather than trying to prevent it,” you should be saying, “maybe my model of cancer is wrong, maybe something else is going on. Maybe, just maybe, something about the metabolism has an influence on the growth of cancerous mutations. What does, how does it, and how can I use this knowledge to my advantage?”

    I have not thrown up my hands and said “its not preventable, lets not try and prevent it.” I just refuse to make up willy nilly just so stories based on garbage anthropological data and nothing but anecdote and say I am convinced it must be so. The HPV vaccine prevents cancer (cervical) but not entirely – it drops the increased likelihood of getting cancer from HPV infection, but you can still get cervical cancer even then. But it drops rates massively, so I recommend it. Limiting sun exposure decreases melanoma, so I advocate that as well. Smoking causes lung cancer, so I advocate smoking cessation. Smoked/charred foods high in nitrites increase risk of gastric cancer, so I recommend avoiding those. All of those are examples of preventing cancer. And eventually we will know more and do better. But I am not about to recommend a paleo diet based on the whimsy of anecdote and bad anthropological data (that is almost redundant) because I am convinced it will prevent all cancer.

    So your closing comment:

    That said, trying to prevent cancer is a much more interesting question, and one that is relevant to many more lives. The fact that you are taking it on faith that there is a subset of cancers that are totally unpreventable is decidedly unskeptical. I am not saying you have to agree with the means by which I am suggesting you go about preventing it, but I am saying that giving up on prevention is going to roadblock you from ever figuring out what is.

    Is absolutely asinine. I am not against learning how to prevent cancer. I am against doing it stupidly, unscientifically, and without a proper knowledge base – something you seem to have no problem with.

    But of course you wouldn’t be able to see that, because you don’t understand how cancer actually happens. Please take Dr. Hall’s advice and read The Emperor of All Maladies before you speak again about cancer.

  22. nybgrus says:

    oh, I missed one important point:

    “If someone can be significantly less susceptible to cancer than someone else, that means that cancer is about much more than the correct series of random genetic mutations lining up. ”

    No. Cancer is about the correct series of random genetic mutations lining up. How those mutations accrue is what the difference is. The octogenarians who die of cancer accrue at a faster rate than those that survive to be 100. In a random population people will accrue at different rates based on all those things (and more) that I described above. Those that accrue the fastest will die earlier (childhood cancer) those that are about average later (the octogenerians) and those that accrue the slowest will die last (the centenarians). Thus, we would expect a steady increase in cancer until it peaks and then drops back off, but not to zero. And that is exactly what we see.

  23. GLaDOS says:

    All those neurotransmitters –dopamine, serotonin, aceytlcholine, etc.– they’re probably doing *something*, amirite?

    With respect to the DSM: a diagnosis is useful if it has high inter-rater reliability, i.e., if doctors in New York see a patient and say, “autism” and doctors in Los Angeles see the same patient and say, “autism,” that means research collaboration and comparison is possible.

    Apart from the reliability issue, does anyone actually care about the number of diagnoses listed?

    Think of the pediatric neurologists and all their congenital syndromes. I don’t know how many there are, but I would say a buttload. My favorite is “Hallervorden-Spatz,” because it is fun to say.

    There are plenty of issues worthy of debate within psychiatry. Condemnation of psychopharmacology and psychopharmacologists generally doesn’t help.

  24. woo-fu says:

    @Becky

    You’re very welcome. They also might be able to direct you to advocacy groups in your area.

    @HH

    Despite their many drawbacks, drugs are effective in controlling the symptoms of schizophrenia, and the evidence that psychosocial treatments can offer similar or superior outcomes is limited and controversial.

    Sadly true.

    However, psychosocial treatments & support are still very important. They can give a person with schizophrenia skills to cope with breakthrough symptoms and side effects of medications, help to minimize feelings of isolation and provide a way to monitor a patient’s status–especially important for patients who skip their medication.

    (I know you realize this Dr. Hall, but I added that comment for those who might have misinterpreted the findings, thinking they meant psychosocial interventions have no benefit at all.)

  25. Harriet Hall says:

    Psychosocial interventions have proven benefit as an adjunct to medication. The evidence for using them without medication is what is limited and controversial.

  26. evilrobotxoxo says:

    @Rob Tarzwell:

    I agree, psychiatry is still in the phase where everything is done by clinical observation. In your example, you list three different types of chest pain, then give three different pathophysiological causes of chest pain. Even in something like chest pain, we can’t reliably distinguish between different causes based on symptomatology alone. In psychiatry, I think this will ultimately turn out to be even more true. There have been times I’ve seen two patients with almost identical clinical presentations, start them both on the same medication, and one gets much better while the other one doesn’t respond at all. This suggests to me that there is likely something different about the underlying pathophysiology of their conditions. I also agree that psychoanalytic theory is completely nonsense sometimes, but at other times I think it’s correct and very helpful. I think psychoanalytic theory deserves respect because, like you said, they actually try to explain things, and sometimes they get it right. However, the entire enterprise largely devolved into a cult devoted to preserving and promoting its own old-fashioned ideas, rather than adopting a scientific model and testing those ideas, throwing out the bad ones, adapting their ideas to incorporate findings from neuroscience, etc. I think Freud isn’t given enough respect because of what people who came after him did, and if we could resurrect him and show him what happened to psychoanalytic theory over the 20th Century, I’m sure he’d be horrified.

    @Becky, Dr. Hall, woo-fu

    The issue with psychosocial interventions vs. medications for schizophrenia is that they’re difficult to compare because they both help, but in different, complementary ways. Medications help with the “positive” symptom cluster. While they’re far from perfect, their overall effectiveness at reducing positive symptoms is dramatic and well-supported by a massive evidence base. However, they don’t have a positive affect on the “negative” and cognitive symptoms clusters acutely, and these are ultimately more debilitating. This is a little more difficult to sort out because there is evidence that they can help decrease negative and cognitive symptoms in schizophrenics in the long run, but most antipsychotics will worsen these symptoms acutely. So there’s some subtlety there.

    As far as psychosocial interventions go, the evidence is clear: if we look just at the symptoms of the illness, their efficacy is nowhere near that of medications. However, I would argue that a strong social support system is actually MORE important than medications for many patients because they enable patients to function better in spite of their symptoms. And ultimately, functional status is more important than symptom level. The reason why psychosocial interventions are not expanded in treatment of mental illness is not because psychiatrists don’t believe in it, because we only want to push pills, because we’re in the pocket of big pharma, etc.; it’s because no one is willing to pay for it, despite evidence that it actually saves money in the long run. If anything, psychiatrists have been pushing for expanded coverage of psychosocial interventions for decades.

    @ Becky

    My sympathies regarding your son. As a soon-to-be father myself, I can’t imagine how difficult it must be to go through what you’ve gone through. Nevertheless, I think it’s important not to demonize an entire class of medications that, believe it or not, actually help a lot of people. Yes, they can have terrible side effects; yes, they don’t always help; yes, they are overused in certain contexts. But to argue that they don’t have a strong evidence base or shouldn’t be first-line treatments for schizophrenia is to take a very one-sided view of things. I know it’s just an anecdote, but you should check out “The Center Cannot Hold” by Elyn Saks, a schizophrenic who is able to be a law school professor because she takes clozapine.

  27. daedalus2u says:

    GLaDOS , the only clinical use of a differential diagnosis is for differential treatment. I think for many of the DSM diagnoses there aren’t differential treatments, so a differential diagnosis (to the extent there is no differential treatment) isn’t worth anything.

  28. evilrobotxoxo says:

    @daedalus2u

    There are other clinical uses of differential diagnosis, including determining prognosis. Not all incurable cancers are the same, for example.

  29. woo-fu says:

    Psychosocial interventions have proven benefit as an adjunct to medication. The evidence for using them without medication is what is limited and controversial.

    I agree, Dr. Hall; I’ve witnessed that firsthand. A friend of the family has schizophrenia. Before medication, he was completely out of control. There was no way he could benefit from other therapies because he simply couldn’t connect. His symptoms dominated his attention and exhausted him physically. After medication, he was able to calm down enough to understand the situation and make progress with coping skills.

    He did have to try several different medications before they found one that worked with his system and minimized side effects. While he doesn’t like being medicated, he’s the first to admit he functions much better and has a better quality of life.

    @evilrobotxoxo

    While I agree that psychosocial support is of great value and shouldn’t be underestimated, I don’t believe that at our current level of practice that it is more important than medication for the reasons I’ve stated above.

    However, I’m not in a position to really judge. The disease can manifest differently and some struggle with much more challenging symptoms than others. This is something to take into consideration.

    A few years ago I read about new techniques used in the Netherlands (I’ll see if I can find the link.) where patients were encouraged to talk back to the voices instead of always actively trying to ignore them. They were also taught components of family therapy and conflict mediation. The idea being that just because you hear a voice telling you to do something doesn’t mean you need to listen. Basically, they were being given social skills to use internally as well as externally. This style of therapy seemed to help deescalate adverse behaviors and give patients some sense of control.

    If I remember correctly, though, these patients were medicated or at least stable enough to benefit from the intervention. Of course, this intervention style is also very controversial since it goes against the old standard of telling the patient to just ignore the voices entirely. I’ll be interested to see further studies in this area.

    On the other hand, while Freud did make significant contributions which cannot be denied, his assumptions and personal biases also caused a lot of damage.

  30. evilrobotxoxo says:

    @woo-fu:

    I apologize if I implied that psychosocial interventions were more important for schizophrenia in general. What I meant is that for SOME patients, they are more important, and those tend to be patients who don’t respond as well to medication.

  31. woo-fu says:

    @evilrobotxoxo

    When I re-read my comments and yours prior to them, I realized you seem to be in the mental health field. If so, perhaps you could clarify how returning to Freudian techniques would be an improvement. I don’t see it, but I’m not an expert.

    Otherwise, I’m in agreement with you regarding psychiatrists; most I know emphasize that medication is only the beginning and that the real work comes from therapy and social support. It is tragic that the few without any empathy for their patients, the few (compared to the total number who practice) who could even be described as abusive are highlighted as a way to disparage the entire field.

    There have been abusive medical doctors, too. But, people don’t generally condemn the entire medical profession because of them. Why is it so different for psychiatry?

  32. woo-fu says:

    @ evilrobotxoxo, it seems we have more in agreement, but how funny we’re probably writing and posting about the same time, so things might get a little confused. I know I confuse myself sometimes. :)

  33. evilrobotxoxo says:

    @woo-fu:

    Yes, I’m in my last year of psychiatry residency.

    As far as returning to Freudian techniques and etc., I absolutely don’t believe that returning to the previous state of things, in which Freudian ideas were the dominant paradigm, would be an improvement. However, I think that there is a tendency for people to bash Freud and psychoanalytic/psychodynamic theory in general for the many things that they get wrong, ignoring all of the important things that they get right. Part of what Rob Tarzwell and I were referring to above is that Freud tried to understand mental illness by coming up with hypotheses of what’s going on internally. The DSM was an effort to try to be “scientific” about mental illness by grouping based solely on what symptoms and signs were reported/observed, ignoring any sort of theoretical conjecturing. I think this goes a step too far, occasionally throwing out useful things that are not objective and replacing them with things that are pseudo-objective without being useful.

    As far as why people love to bash psychiatry preferentially over other fields of medicine, there is a long list of reasons, and I don’t pretend to know them all.

  34. Rob Tarzwell says:

    @woo-fu: Regarding Freud, there are, I would submit, three important contributions he made which needed to be considered separately:

    First, he attended very carefully to the things his patients said, creating within the analytic hour, the freedom for the patient to say absolutely anything without fear of reprisal or condemnation. This shift in technique was itself important and revolutionary, perhaps one of the single biggest revolutions in mental health. That he managed to accomplish this in Victorian Europe amazes me to this day, as it is a strikingly egalitarian move.

    Second, he posited a theory of the mind which he in fact altered several times over the course of his career and posited would one day be swept away by discoveries in neuroscience. Classical Freudian psychoanalytic theory was not static, though it did, unfortunately, ossify. For instance, analysts really, *really* hated John Bowlby’s attachment theory, though it grew out of Freudian soil and offered an empirical, testable model of developmental psychopathology which has completely revolutionized psychiatry.

    Third, he developed a series of techniques via which he hoped to gain therapeutically important access to the pathological forces in the lives of his patients. Over time he moved from hypnosis to free association and finally to dream analysis. He recognized that he hadn’t completed the job and in fact admitted quite frankly that certain forms of resistance were impervious to psychoanalysis.

    Furthermore, psychodynamics has continued to grow and evolve, as has psychoanalytic theory and practice, though it did sadly ossify for a long time. The psychodynamic theories and practices of today resemble classical psychoanalysis as much as a modern car resembles an 1899 Daimler. Psychodynamic psychotherapies are empirically validated, with moderate to large effect sizes across a broad range of conditions. They are based on the empirical developmental psychopathology of attachment trauma, and with the introduction of video-recorded teaching and research, large gains have been made in reliability and validity of operational and theoretical concepts.

  35. woo-fu says:

    @ Rob Tarzwell & evilrobotxoxo:

    Thanks for your clarifications. And I must say I find nothing to disagree with here. Freud certainly had his own issues, but they cannot erase or undo the significant contributions he made. (I hope I didn’t seem to imply that in my prior comments.)

    I also agree that clinical practice, even as many great discoveries have been made and new practical techniques developed, in many ways has also devolved. From my perspective, insurance-backed, time-limited mini-analysis or group therapy is often substituted for more intensive individual work. There is a place for these methods (they can work well as support groups or helping individuals attain specific short-term goal-oriented objectives), but they cannot replace traditional psychotherapy, especially for more serious mental health issues.

    BTW one of my first public speaking assignments in Jr. High required us to pick a major contributor/inventor/researcher–someone who radically changed the way the world saw itself– research his/her life and then teach the class through lecture. I picked Freud.

    Evilrobotxoxo–all the best in your studies!

  36. libby says:

    @evilrobotxoxo

    You state: “As far as why people love to bash psychiatry preferentially over other fields of medicine, there is a long list of reasons, and I don’t pretend to know them all.”

    You don’t have to look far.

    The US (CIA) and Canadian Governments funded human experiments in Montreal in the 1950′s under the leadership of D. Ewen Cameron, involving non-consenual electro-shock therapy, all manner of drugs including Strychnine (inducing paralysis), sensory deprivation via total isolation, etc

    You can still find the results of his discoveries in the following sources:

    Ewen Cameron, , American Journal Psychiatry, vol. 112, n 7, 1956, pags 502-509

    Ewen Cameron and S.K. Punde, , Canadian Medical Association Journal, vol. 78, Jan 15, 1958, pag 95

    Ewen Cameron, <Production of Differential Amnesia as a Factor in the Treatment of Schizophrenia, Comprehensive Psychiatry, vol 1, n 1, 1960, pags 32-33

    Ewen Cameron, J. G. Lobrenz and K. A. Handcock, , Comprehenseive Psychiatry, 3, n 2, 1962, pg 67

    Ewen Cameron et al, , Symposium on Psychophysiological Aspects of Space Flight, New York, Columbia University Press, 1961, pag 231

  37. libby says:

    copy error correction:

    Ewen Cameron, psychic driving, American Journal Psychiatry, vol. 112, n 7, 1956, pags 502-509

    Ewen Cameron and S.K. Punde, Treatment of the Chronic Paranoid Schizophrenic Patient, Canadian Medical Association Journal, vol. 78, Jan 15, 1958, pag 95

    Ewen Cameron, Production of Differential Amnesia as a Factor in the Treatment of Schizophrenia, Comprehensive Psychiatry, vol 1, n 1, 1960, pags 32-33

    Ewen Cameron, J. G. Lobrenz and K. A. Handcock, The Depatterning Treatment of Schizophrenia, Comprehenseive Psychiatry, 3, n 2, 1962, pg 67

    Ewen Cameron et al, Sensory Deprivation Effects upon the Functioning Human in Space Systems, Symposium on Psychophysiological Aspects of Space Flight, New York, Columbia University Press, 1961, pag 231

  38. woo-fu says:

    @Libby

    The problem I have is that atrocities have been committed throughout the history of many industries (speaking here of medicine in particular and also the greater fields of science & technology, in general), but mankind did not reject those discoveries, later proven more ethically, from other fields, so why isolate psychiatry as an exception?

    Note this does not mean I condone unethical behavior as a method for learning. But I am suggesting it is foolish to turn one’s back on prior proven knowledge, even as we demand improvements in those fields.

  39. libby says:

    @ woo-fu:

    Agreed. But it does show us to what extent things can get out of control if left unchecked.

    My story about Zomax and McNeil Pharmaceuticals hiding safety concerns within the courts system and continuing to sell and reap the profits from a drug they knew was dangerous means that problems are still with us, although the case of Ewen Cameron is an extreme example of that no doubt.

  40. RQbrain says:

    Thanks Harriet for posting this.

    A friend sent me this review to read and it was very upsetting as someone who takes medication for psychiatric reasons.

    Reading your article helped balance the negativity.

  41. evilrobotxoxo says:

    @Libby:

    I agree that the checkered history of the field explains a small part of it, but this is hardly unique to psychiatry. The Tuskegee syphilis study was more horrifyingly unethical than anything in the history of psychiatry, yet you don’t see anti-penicillin web sites. I think there are a bunch of reasons, but I think the primary one is still the fact that the average person does not have any significant exposure to mental illness. Most people with mental illness are either incarcerated or hospitalized, hiding in their homes, or doing everything they can to hide their symptoms from everyone else. Neuropsychiatric illness is the #1 greatest disease burden in society, greater than either cardiovascular disease or cancer. According to some estimates, it costs the US $300 billion per year. However, the public’s perception is wildly out of line with this. As a result, psychiatry is thought of as a field aggressively overmedicates conditions that don’t exist, are “all in their heads,” are wildly overdiagnosed or overpathologized for financial gain, etc.

  42. WilliamLawrenceUtridge says:

    Agreed. But it does show us to what extent things can get out of control if left unchecked.

    My story about Zomax and McNeil Pharmaceuticals hiding safety concerns within the courts system and continuing to sell and reap the profits from a drug they knew was dangerous means that problems are still with us, although the case of Ewen Cameron is an extreme example of that no doubt.

    Again I find it questionable to criticize medicine for this, but not alternative medicine. CAM has fewer controls, fewer oversight bodies, an evidence base that is best described as a tripod missing a couple legs and mostly defines itself in terms of criticism of a legitemate field. It’s the creationism of medicine. The only thing that “saves” it is that most of its interventions are inert – bar perhaps herbal medicine (an unmonitored delivery vehicle for an unmeasured dosage of a molecule of uncertain effectiveness). In cases where genuinely dangerous CAM treatments exist, such as laetrile, despite the dangerous and the lack of efficacy, people still sell it.

    But yeah, Big Pharma is evil, that justifies giving people cyanide poisoning. Big Pharma has checks on it, Big Herbal, Big Sugar and Big Needle does not, but somehow only one of those is evil.

    Curious.

  43. evilrobotxoxo “think there are a bunch of reasons, but I think the primary one is still the fact that the average person does not have any significant exposure to mental illness. Most people with mental illness are either incarcerated or hospitalized, hiding in their homes, or doing everything they can to hide their symptoms from everyone else”

    I think you are spot on with this. Most people I know believe in some Fischer King/Beautiful Mind romanticized version of mental illness, that has no resemblance to real psychosis.

    And most people don’t have to deal with the consequence of that psychosis in a friend or loved one, so they don’t worry about it to much.

  44. nybgrus says:

    To build on evilroboto and michelle’s points, I think it is furthered by the fact that mental illness is generally stigmatized – either you are crazy or you are making it up for attention. The old “cowboy” mentality of the states held no quarter for something mental (which was intangible) and the answer was always “suck it up! be a man!” and for a long time that is what people did. Except those telling others to suck it up saw that as validation that it was just all in the others’ heads, whilst in reality they were just suffering in silence and/or getting institutionalized. I’m sure there is more nuance and detail to it, but that is my impression of the general gist.

  45. libby says:

    @ evilrobotxoxo:

    You state:

    “Neuropsychiatric illness is the #1 greatest disease burden in society, greater than either cardiovascular disease or cancer. According to some estimates, it costs the US $300 billion per year. However, the public’s perception is wildly out of line with this.”

    Why people perceive things the way they do is an interesting and complex study. However what we are left with is the fact that misperceptions exist, and there are ways to alleviate or eliminate such things when the opportunity arises.

    On this board I have tried to convince doctors to support legislation already drafted and passed in a few States that would prevent pharma companies from hiding safety concerns (SLA), but the doctors here have opted to remain silent on the issue, reinforcing the perception that the ties between physicians and drug companies are too close for the patient’s good.

    1. Harriet Hall says:

      @libby,
      “On this board I have tried to convince doctors to support legislation already drafted and passed in a few States that would prevent pharma companies from hiding safety concerns (SLA), but the doctors here have opted to remain silent on the issue, reinforcing the perception that the ties between physicians and drug companies are too close for the patient’s good.”

      I support such legislation, and I’m sure the rest of the SBM doctors do too. You didn’t have to convince us. How could any reasonable person NOT support such legislation? Just because we aren’t as vocal about it as you would wish, or as angry and emotionally involved as you are, that’s no reason for you to assume we have ties with drug companies. We don’t have any such ties, much less ties that are “too close for the patient’s good.” You are playing the Pharma Shill gambit, and it won’t fly. I don’t know how you meant it, but it comes across as a false accusation and a gratuitous insult.

  46. Oh look! more off topic political spam. surprise, surprise.

  47. libby says:

    HH:

    “We don’t have any such ties (between drug companies and physicians), much less ties that are “too close for the patient’s good.” ”

    A study in JAMA belies the testimonial evidence you proffer, the result of the ties they referred to as “non-rational prescribing”. If a doctor is committing the act of non-rational prescribing, how can that be in the patient’s interest?

  48. daedalus2u says:

    libby, HH is not speaking for all doctors, she is speaking for the health professionals who blog on SBM. She is in clear disagreement with many doctors, particularly those who use non-science based treatment modalities. Non-rational prescribing would be an example of non-science based prescribing.

    You are preaching to the prophets who wrote the book on rational based medicine.

  49. libby says:

    @daedalus2u

    If HH is telling the truth regarding physicians’ silent support for corrective legislation, this is hardly adequate to alter the perception of the connection between drug companies and physicians.

    1. Harriet Hall says:

      @libby,

      “If HH is telling the truth”

      That is really offensive. When you told us about your experiences, no one said “If libby is telling the truth.”

    2. Harriet Hall says:

      @libby,

      ” this is hardly adequate to alter the perception of the connection between drug companies and physicians.”

      Is it our responsibility to alter your perception? What would be “adequate”? What would you have us do, march in the streets? I’m beginning to wonder if anything could ever penetrate your barrier of anger to alter your perceptions. We have spoken out in these pages about drug company tactics we disapprove of, about undue influence, and about rejecting even token gifts from pharmaceutical reps.

  50. I think Libby is offering an excellent demonstration of how mental illness is ignored today. It appears she has no connection with someone who is mentally I’ll, so she has to resort to history books to come up with any opinion.

    Then, since the hard realities of mental illness are to uncomfortable to contemplate, she changes the subject.

  51. Scott says:

    If HH is telling the truth regarding physicians’ silent support for corrective legislation

    I support such legislation, and I’m sure the rest of the SBM doctors do too.

    Anybody else notice how grossly the former quote distorts the latter? And after having already been called on that in the post to which it was a reply.

  52. WilliamLawrenceUtridge says:

    Though to be fair, we have in the past said libby is deluded, wrong, obstinate, ignorant, arrogant, arrogant of her ignorance, selective in her citations, seletive in her readings, attacking straw men, resolving her cognitive dissonance by refusing to read an alternative point of view, and I’ve used reductio ad absurdum to demonstrate that she is in fact a National Socialist of the 1930s German type.

    And to be fair to us, I believe what we said can be supported to a significant degree. She’s pretty much masturbating at this point anyway, spouting off what she already beliefs and ignoring any counter-points.

    Don’t forget, she’s also a hypocrite for insisting on more stringent controls over drug companies while ignoring the fact that sellers of herbal and homeopathic products exist in a complete quality and effectiveness vaccuum.

    But she’s great at repeating CAM talking points. She’s the Michelle Bachmann of CAM.

  53. weing says:

    I think Michelle Bachmann is hot. That just proves, there is no accounting for taste.

  54. Harriet Hall says:

    @ WLU
    “Though to be fair, we have in the past said libby is deluded, wrong,…etc.”

    We have attacked her facts and her reasoning.
    People are welcome to question my facts and my reasoning any time. I can usually defend myself; and if they can produce convincing evidence that I am wrong about something, I am happy to recognize it and change my mind.
    Libby crossed a line when she questioned my honesty. It never would have crossed my mind to question her honesty.

  55. WilliamLawrenceUtridge says:

    weing, ever heard of Matt Taibbi? He has things to say about Michelle Bachmann, including her creepy hotness. I recommend.

    HH, I’ve been steadily mocking libby for a while now (in addition to refuting her points) because she’s consistently pulled Chewbacca defence and when called on it, decides to ignore everything I say. Naturally, the result is she doesn’t even have to pretend to deal with my points anymore. Libby doesn’t deserve any respect whatsoever on a blog devoted to science. If she’s not going to work with facts or logic, I’m not even going to give lip service toward civility. She’s a deluded nut who is so convinced she is right, she’s not even willing to find out why she is wrong. The only merit in engaging with her is to refute her points so other people don’t find them superficially convincing.

  56. Chewbacca* defence?

    That’s a new one. Is it, like, howling at things until they go away?

    (really, the most emotionally believable of Star Wars character)

  57. WilliamLawrenceUtridge says:

    Nope, it’s a South Park-spun version of a red herring:

    Chewbacca defense

    If you’re visually oriented, you can enjoy this on YouTube.

    Though howling at things until they go away might work as well.

    As a wikipedia editor, I’m astonished that this does indeed appear to be a page that passes notability. Well I’ll be condemned to an afterlife of suffering I don’t believe in!

    Also, I just realized Bachmann is one “L” and two “N”s. Spelling is important!

  58. yes one “L”… It kills me to admit she is a sister one “l” Michele.

    Obviously, her mind has been twisted by people singing a Beatle’s ballads at her… My mind too, but in the opposite direction.

  59. WLU, Thanks for the CD explanation. I’ve never been able to handle South Park, so I miss out on important pop culture references.

  60. libby says:

    HH:
    You state: “I support such legislation, and I’m sure the rest of the SBM doctors do too.”

    The support for SLA by SBM doctors has been, well, rather underwhelming. There is no mention of it in any article on this board.

    You state: “Just because we aren’t as vocal about it as you would wish, or as angry and emotionally involved as you are, that’s no reason for you to assume we have ties with drug companies. We don’t have any such ties, much less ties that are “too close for the patient’s good.””

    There are reasons. The JAMA study is only one. Stanford University Medical Centre addresses the problem with a policy that drastically curbs pharma influence on campus. You can read the policy on their website.

    http://med.stanford.edu/news_releases/2006/september/coi.html

    You might be interested to read a quote by Philip Pizzo, Dean of Medicine at Stanford:

    “In recent years we have witnessed an erosion of the public trust in the profession of medicine and even in the value of science,” Pizzo said. “Part of that is related to the market forces that have increasingly converted medicine from a profession to a business, but a significant factor has also been the perception that physicians and scientists may be accepting gifts and gratuities from industry at the very time that the cost of drugs is skyrocketing.”

    You state: “Is it our responsibility to alter your perception (of the connection between drug companies and physicians)? What would be “adequate”? ……………..We have spoken out in these pages about drug company tactics we disapprove of, about undue influence, and about rejecting even token gifts from pharmaceutical reps.”

    “Adequate” is a subjective term. Writing about it is better than ignoring it. Creating policies that curb or eliminate such conflicts of interest, as Stanford has done, is a superior approach.

    “We have attacked her facts and her reasoning.”

    If by “we” you mean everyone on this board, then that is a falsehood.

  61. Harriet Hall says:

    @libby,

    “If by “we” you mean everyone on this board, then that is a falsehood.”

    If by “doctors” who have ties with Big Pharma you mean any of us on this blog, then that is a falsehood.

  62. Jeez, the trolls are bad this time of year.

  63. libby says:

    HH:

    “If by “doctors” who have ties with Big Pharma you mean any of us on this blog, then that is a falsehood.”

    A straw-man argument.

  64. weing says:

    “In recent years we have witnessed an erosion of the public trust in the profession of medicine and even in the value of science,” Pizzo said. “Part of that is related to the market forces that have increasingly converted medicine from a profession to a business, but a significant factor has also been the perception that physicians and scientists may be accepting gifts and gratuities from industry at the very time that the cost of drugs is skyrocketing.”

    They really must have taken this to heart to the extent that they are abandoning science. Stanford has a department of integrative medicine and acupuncturists on staff. I don’t know whether they have reiki practitioners too. They have banned pharmaceutical reps and advertisements from patient care areas as inappropriate and unnecessary but allow charlatans to market there.

    What’s wrong with that picture?

  65. Harriet Hall says:

    @libby,

    You said “If by “doctors” who have ties with Big Pharma you mean any of us on this blog, then that is a falsehood.”
    was a straw-man argument.

    And yours wasn’t??!! Did I mis-read what you wrote? I don’t remember you exempting the doctors on this blog from your general accusation of ties with Big Pharma and ensuing harm to patients.

  66. libby says:

    HH:

    ‘You said “If by “doctors” who have ties with Big Pharma you mean any of us on this blog, then that is a falsehood.”
    was a straw-man argument.’

    That is correct.

    And yours wasn’t??!!

    That is correct.

    Did I mis-read what you wrote?

    Yes.

    “I don’t remember you exempting the doctors on this blog from your general accusation of ties with Big Pharma and ensuing harm to patients.”

    The answer is in your own sentence. “General accusations” are by their very nature not specific to any one person or to a specified small sub-group of people.

    Besides these are not my personal baseless accusations, but information based on a JAMA study, as yet falsified, and medical center policies and statements from the Stanford University Medical Center.

    Your statement that there is “….no reason for you to assume we have ties with drug companies. We don’t have any such ties….” is not supported by any evidence other than testimonial evidence, something you have previously vilified.

  67. Harriet Hall says:

    @libby,

    “Your statement that there is “….no reason for you to assume we have ties with drug companies. We don’t have any such ties….” is not supported by any evidence other than testimonial evidence, something you have previously vilified.”

    Now you’re really being ridiculous. What kind of evidence could I possibly provide that would convince you I don’t have any ties with drug companies? Don’t you see that the person making the claim is the one who must provide evidence?

  68. Scott says:

    Well, strictly speaking, “I don’t have any ties with drug companies” is a claim for which one could claim that the person making it must provide evidence. But it’s also the sort of claim for which the statement of the person in question is normally considered in itself reliable evidence unless contradicted. (i.e. unless it can be demonstrated that the person is a liar)

  69. libby says:

    HH:

    “Now you’re really being ridiculous.”

    I disagree.

    “What kind of evidence could I possibly provide that would convince you I don’t have any ties with drug companies?”

    I’m not interested whether or not you personally have ties to drug companies. I am interested in the fact that drug companies spend 90% of their marketing budget gifting doctors, a whopping $19 billion dollars a year.

    “Don’t you see that the person making the claim is the one who must provide evidence?”

    I made no such claim.

    Even if I were interested in investigating your personal status with drug companies, it would be almost impossible to acquire such information. Furthermore, possession of such information would be of no interest.

  70. Harriet Hall says:

    @libby,

    May I remind you that you said

    “I have tried to convince doctors to support legislation already drafted and passed in a few States that would prevent pharma companies from hiding safety concerns (SLA), but the doctors here have opted to remain silent on the issue, reinforcing the perception that the ties between physicians and drug companies are too close for the patient’s good.”

    And you said “If HH is telling the truth”

  71. nybgrus says:

    now I am confused. First Libby offers a reasonable anecdote regarding her own depression. Then she moves on to claim the rationale for bashing psychiatry is because of the unethical experiments once done in the field. Then hammers in the point about what happens in extreme situations, and mentions some of the abuses by the pharmaceutical industry. Then all of a sudden slips in to claiming that she has tried to convince the physicians here to be supportive of protective legislation that would curb such pharmaceutical abuses. In the same breath she says that the physicians here have remained silent on the issue, which to her reinforces the perception that doctors have ties too close for comfort with pharma. Dr. Hall rebuts, saying the physicians on this blog have no such ties and indeed have posted about the topic before and denounce such abuses and support the rectification of the problems (and denounce physicians that act otherwise).

    Now here is where it gets interesting: Libby started the claim about the physicians on this blog, Dr. Hall countered, and Libby’s rebut is a JAMA article about physicians as a whole. In other words – a straw man.

    Dr. Hall rebuts once again, and further confirms the authorship of this blog to be against such practices as Libby describes (including that JAMA article). Libby’s response is deprecatory, saying if Dr. Hall was telling the truth, the job that the authorship here is doing is not satisfactory to dispel the conclusion of the JAMA article. In other words, SBM simply isn’t living up to Libby’s demands on what they should be doing. She even calls the support “underwhelming.”

    Dr. Hall addresses this directly and once again says the authorship here has no such ties, regarldless of whether they are doing a “good enough job” dispelling that according to Libby and thus Libby as no reasons to assume such ties exist. She responds by once again citing the JAMA article as proof that the physicians here must have such ties – once again, straw man and irrelevant to the accusation.

    In finishing out that comment Libby goes on to, in essence, demand that the authorship of this blog change their focus to what she wants the blog to be about – namely, vociferously advocating for the changes called for in the JAMA article.

    Dr. Hall once again clearly states that the authorship here is not described by the JAMA article. Libby decides that is somehow a straw man, even though that has been the crux of her argument.

    Libby then devolves into conflating the two aspects of the argument – 1) That the authorship here is in the thrall of ‘Big Pharma’
    - 2) That overall there is too much ‘Big Pharma’ influence on medical practice

    Libby defends this tactic by saying that since the JAMA article is about the profession in general that a general accusation also encompasses the authorship here, and therefore is valid and the JAMA article is sufficient evidence of this. Circular logic conflating those two points above and creating straw men is all that Libby has accomplished. This is further evinced by conflating the testimonial evidence (claim) provided by Dr. Hall that the authorship here is not defined by that JAMA article and saying that is not sufficient to counter the article.

    And now in her latest post she shifts gears again and says she is not interested in the ties the authorship here has but is only interested in the ‘Big Pharma’ practices of spending $19B/yr on physicians. And suddenly whether Dr. Hall has personal ties or not is “of no interest” to Libby. Yet, the start of her argument/accusation was definitively about the authorship here and the rest of the argument up until that comment was spent conflating two separate populations of physicians.

    I can order your comments one after another and read them sequentially, Libby, which is exactly how I came up with that synopsis of the argument. I suggest you try and do the same and see why many here are calling you a troll. You are not arguing soundly and you are making wild accusations and then conflating evidence and data all over the place to make it possible for you to say anything, regardless of what Dr. Hall or anyone else here says.

    If you are actually interested in learning more and applying that knowledge, please do so. Otherwise, continue to sling your accusations, poor argumentation, and demand this blog change to suit your desires all you want – we’ll just keep (rightfully) calling you a troll for it.

  72. libby says:

    HH:

    “I have tried to convince doctors to support legislation already drafted and passed in a few States that would prevent pharma companies from hiding safety concerns (SLA), but the doctors here have opted to remain silent on the issue, reinforcing the perception that the ties between physicians and drug companies are too close for the patient’s good.”

    And you said “If HH is telling the truth”

    You’re not telling the truth.

    I see nothing above showing that I said that you have ties to drug companies.

    I presented the evidence on gifting from JAMA and Stanford. I also clarified that a general accusation, your phrase, DOES NOT SPECIFY any individual or any small sub-group.

    1. Harriet Hall says:

      libby,

      Nybgrus is right. Whatever your true intention, your words can only be interpreted as implying the doctors on this list have ties to Pharma.

      This time you didn’t just question whether I was telling the truth, you asserted that I wasn’t: “You’re not telling the truth.”
      I don’t appreciate being called a liar.

  73. nybgrus says:

    Try this on for size Libby:

    On this board I have tried to convince doctors to support legislation already drafted and passed in a few States that would prevent pharma companies from hiding safety concerns (SLA), but the doctors here have opted to remain silent on the issue, reinforcing the perception that the ties between physicians and drug companies are too close for the patient’s good.

    and then in direct response to Dr. Hall’s:

    “We don’t have any such ties (between drug companies and physicians), much less ties that are “too close for the patient’s good.”

    Which you quoted yourself! And then responded:

    A study in JAMA belies the testimonial evidence you proffer, the result of the ties they referred to as “non-rational prescribing”. If a doctor is committing the act of non-rational prescribing, how can that be in the patient’s interest?

    So, either you are completely unaware of how the English language works in using definite articles and pronouns, or you are simply trolling. It is plainly clear that you accused the physicians here of “such ties,” on Dr. Hall’s post. Clearly that indicts Dr. Hall specifically and the remainder of the authorship. And when directly confronted you could have rectified the issue had it been a mistake. A simple, “Oh no, I didn’t mean you specifically. I meant it was a general problem that you here don’t address enough for my liking” would have cleared the air quite nicely. Instead you offered the JAMA articles as evidence that Dr. Hall’s “testimonial evidence” about a lack of “such ties” was incorrect.

    Seriously Libby – you are either very bad at arguing/holding a conversation or you are just trolling around your particular opinion with no regard for anything else.

  74. Nybrgus, yup, that’s a good summary of Libby’s last three threads.

    The best part is when she uses a study done by physicians and published in a physicians organization to claim that physicians aren’t interested in curbing the influence of pharmaceutical companies.

  75. nybgrus says:

    Michele:

    That is also a very good point I had not considered!

    Oh well, I just wanted to summarize how false Libby’s argument was for the casual reader then. :-)

  76. daedalus2u says:

    I think there is a third option, that libby is unable to perceive the conflict between her mutually incompatible ideas. I think this is the real reason and is extremely common in non-scientists (and even in scientists).

    Ideas are thought about, and whether they are perceived to be in conflict or not is determined by the feelings of the person thinking about the ideas. This is what leads to doublethink, the ability to hold two mutually incompatible ideas, believe them both, while knowing that they are incompatible but feeling and so believing that they are not.

    I don’t think that libby is trolling, I think she genuinely can’t recognize that her chain of thought is inconsistent because it feels consistent to her. It is a delusional state, where the belief that the ideas are consistent is maintained in the face of overwhelming evidence that they are not.

  77. weing says:

    She definitely has an agenda which involves the “pharma is bad” bandwagon and wants everyone to get on that with her. She doesn’t want pharma to influence physicians because we are guilty of irrational prescribing until proven otherwise. In her mind, the SCAM artists should influence physicians, doctors in training, and patients, as SCAM is rational prescribing by definition.

  78. WilliamLawrenceUtridge says:

    Daedalus, you stole my point! I’ve referenced the applicability of Mistakes Were Made to Libby several times now. The core of her postings are:

    a) Big Pharma Is Bad
    b) CAM Is Good
    c) Everyone Who Disagrees With Me Is Part Of A
    d) I Am Smart And Can Not Be Wrong

    And evidence must be tortured or ignored to support these points. It’s simple cognitive dissonance – Libby can either stick to her guns (thus preserving d) or realize that she was wrong (thus violating d and realize that she is in fact Not So Smart As She Believes).

    This is why she simply refuses to address well thought-out criticisms of her ideas (and in many cases simply refuses to read them). She can’t bring herself to admit she might be wrong.

    Good book, everyone should read it. It bludgeons you over the head with its central point repeatedly, presumably because the authors realize it takes a massive investment of carefully presented evidence to start people down the road to changing their minds. Insulation against criticism (or even acknolwedging criticism) is an excellent means of avoiding change.

    I consider the merit of criticizing her points to be helping readers who might find them convincing. Libby is unlikely to change her mind, simply because she is unlikely to engage with any criticism in a meaningful way.

    Naturally, I’ve made up my mind about Libby and will resist changing it because I’m a human and we all do it. Is that irony? I’m never sure.

  79. JPZ says:

    @WLU

    Thanks for the “Mistakes were Made” book suggestion. It looks interesting! I’ll see if our library has a copy.

  80. daedalus2u says:

    WLU, yes it is to avoid narcissistic injury that compels people to never admit when they are wrong, especially to themselves. If you have to do that, you can never be a skeptic.

  81. weing says:

    I was wrong once. I thought I was wrong, but I was in fact right. Still counts as being wrong.

  82. pmoran says:

    Libby does illustrate how “alternative” medicine is a “problem” of trust rather than of science, also that once trust is lost it is not easy to get it back.

    The weird thing is that drug company influence is one of the least likely sources of bad outcomes from conventional medical care.

    Yet it seems to be the focal point of Libby’s mistrust.

  83. libby says:

    @ pmoran:

    What’s interesting about the JAMA study was that no doctor believed that gifting influenced their prescribing, although in many cases it did.

    When you say “drug company influence is one of the least likely sources of bad outcomes from conventional medical care”, it implies that the $19 billion dollar a year marketing figure earmarked for doctors is an awful waste of a staggering amount of money.

    Something to investigate, and it rests on my shoulders, would be to find out how much, if any, gifting goes on outside of conventional medicine towards homeopaths, naturopaths, acupuncturists, etc.

    Again always enjoy your thoughtful posts.

  84. woo-fu says:

    @libby

    Something to investigate, and it rests on my shoulders, would be to find out how much, if any, gifting goes on outside of conventional medicine towards homeopaths, naturopaths, acupuncturists, etc.

    I have discussed this and witnessed this among alternative practitioners as well as M.D.s wanting to monetize their practice. Some device manufacturers offer sweet incentives to buy into their “tech.” Even testing labs and pharmaceutical grade supplement manufacturers offer kickbacks. Great Smokey Mountain Labs I believe was one (now Genova ?) and Doctors’ Data I believe was another. (I’m not positive about the names, as this discussion took place a few years ago.)

    And as far as homeopathic remedies and acupuncture goes, that’s low overhead for a lot more profit, especially if the practitioner makes their own remedies, and far more do these days.

  85. nybgrus says:

    Libby, well done. You completely ignored all the reasoned criticism of your argumentation and latched on to the one tiny positive you have.

    Good points woo-fu. Indeed, the concept that somehow the homeopathy, naturopathy, acupuncture, supplement, and CAM industry in general isn’t all about insane amounts of profits is ludicrous.

  86. weing says:

    nybgrus,

    It’s not only about the insane amounts of profits. It’s also about the lack of any accountability whatsoever. Caveat emptor.

  87. libby says:

    # daedalus2uon:

    You talk of a 3rd option, but my 3rd option is quite different, and of an anthropological nature.

    The critiques of my posts are of a depressingly low intellectual level, full of distortions, misrepresentations and misinterpretations. No objective observer would think otherwise.

    But notice that these critiques bear two important functions.

    We are not talking about the far more important issues of gifting and transparency. We are focused entirely on a bash-Libby campaign. Look at the time spent and the length of the posts dissecting what I said, trying to find anything that might be possibly misinterpreted in such a way as to show inconsistency.

    So the bashing campaign functions very well as a distraction, but it gets even more interesting.

    We’re acquainted with the fact that gregarious mammals organize themselves around a hierarchical system, and there are punishments for those who challenge the system – banishment, perhaps death.

    Similarly, posters on this board feel compelled to create and support distortions of my posts not because they profoundly believe the distortions, although that is possible, but they are strengthening the bonds within the system and their position within it (That is where the genuine doublethink exists on this thread). Notice they rarely levy any criticism against the system, other than the occasional lip-service such as nothings perfect, etc.

    Of course the posters’ survival is not actually at risk. After all, message boards are completely safe due to anonymity, but the feeling is still there – protect the system, protect the structure, increase the chances for survival. Punishing miscreants (Libby) is a vital part of the structure of the system.

    A practical example of group systems is found in military training, based very much on the style of separating the ‘sissies’ from the ‘real men’. This results in stronger bonds among those who exhibit ‘manly’ qualities, and ultimately strengthens the fighting force in preparation for battle, i.e. the system. Military experts understand group dynamics very well.

  88. nybgrus says:

    Libby, your 3rd option is massive denial. You really are rather deluded if you truly believe what you are writing.

    Perhaps you haven’t noticed, but there have been times when I myself as well as many othe regular posters here have made a gaff or been wrong in an assertion. The commentariat here adequately calls out such errors as well. In my personal experience, I have listened to the arguments, and either refuted them or adjusted my position accordingly. You do not address the arguments and you hold to your position no matter how many people demonstrate to you in innumerable ways your errors.

    I did not seek to find ways to distort your argument. I carefully and honestly laid it out and demonstrated why it was false. You have not addressed that and once again you feint to your “lets talk about the transparency of big pharma and gifting practices” mantra.

    Sorry Libby, but you are only fooling yourself.

  89. weing says:

    “We are not talking about the far more important issues of gifting and transparency.”

    No. We are talking about the far more important issue of science based medicine as opposed to faith or testimonial based medicine and allocating our limited resources accordingly. If we made gifting by pharma illegal, would you then work on removing the SCAM of homeopathy, energy medicine, etc from our medical schools and demand that the federal funding for it be cut off? I somehow doubt it.

  90. pmoran “Libby does illustrate how “alternative” medicine is a “problem” of trust rather than of science, also that once trust is lost it is not easy to get it back.”

    Can you explain to me how the writers of this blog have lost the publics trust by accepting gifts from pharmaceutical companies?

    pmoran, libby has shown no evidence that this blog or any of the writers have ties to pharmaceutical companies. Yet she has repeatedly assumed that they do. When one of the writers (HH) points out that she has no ties to pharmaceutical companies and does not accept gifts, then Libby implies that she is lying.

    Yes, once trust is lost it is hard to get back. Many of the people who were called to testify during McCarthyism and lost their jobs or liberty took decades to get it back.

    Should we base who we put our trust in on evidence regarding the actions of the individual or assumptions based on that individuals associations and profession?

  91. libby says:

    This board is quite a good example of the mechanics of propaganda. It’s quite simple: you keep repeating THE LIE.

    It’s how Fox News functions (Obama is a Muslim), how Republicans function (Obama’s health care plan will cost $900 billion), how Nazi Germany functioned (the Jews are destroying Germany), how male chauvinism functions (women should stay in the kitchen).

    The BIG LIE, repeated here by the supporters of the system, is that I specifically accused the handful of doctors on this board of ties with drug companies. For those who misinterpreted my original post because of sloppy reading, I even clarified the point on two separate occasions in two different ways.

    No matter. THE LIE continues. The clarifications are lost in the thread.

    I actually find this quite interesting and appreciate many of you for providing me with such a clear example of propaganda in action.

  92. weing says:

    “It’s how Fox News functions (Obama is a Muslim), how Republicans function (Obama’s health care plan will cost $900 billion), how Nazi Germany functioned (the Jews are destroying Germany), how male chauvinism functions (women should stay in the kitchen).”

    You forgot to add how libby functions (pharma is bad, homeopathy is good, science is no good unless it gives me the answers I want). All you had to do was to look in the mirror to see propaganda in action.

  93. daedalus2u says:

    One of the good ideas that Reagan had was “trust but verify”. That idea has been completely lost in present day politics and in everyday life.

    Now it is “mistrust and assume the opposite” unless the person is in your “camp”, and then it is “trust and never question”.

    “Trust” is about following top-down authority. “Verify” is about deriving a conceptualization of reality from the bottom-up, from facts and logic.

    “Trust” is a product of emotion, not of logic. Emotion is in the brain and physiology of the person experiencing them. Emotions are not something that can be controlled externally and one shouldn’t allow external control to dictate your emotions.

    Reagan didn’t mean blind “trust”, what he meant was act and behave and treat your opponent as if your opponent was telling the truth, but verify that your opponent was telling the truth.

    Now it is blind “mistrust” where no matter what your opponent says he is not to be believed, and no matter what position he adopts that position is not the correct one, even if that was the position that you held moments before your opponent adopted it. This is a recipe for never-ending conflict. This is how Libby is treating Dr Hall. No matter what Dr Hall says, she is dismissed as disingenuous. This is not how Dr Hall is treating Libby. Libby’s statements are taken at face value, checked against facts and found to not hold up.

    I think this way of interacting is the human default under conditions of very high stress and serves to generate “camps” that as the stress level goes up (in evolutionary time this was due to food insufficiency) eventually there will be violent conflict until one of the camps is eliminated. Desperate people behave this way because desperate people who did not behave this way were not members of groups that survived. Violence by members of a group that is acting this way is to be expected, and is observed.

    The physiology and the default mental state characteristic of very high stress is something I think a great deal about. These states are mediated by physiology, and that physiology is regulated by signaling. Perturb the signaling and you affect the physiological state. High stress states are low NO states. The raising of NO via the placebo effect by charismatic CAM providers or by the triggering of feelings of safety by a charismatic leader with a plan to eliminate whatever the stress is blamed on reinforces the belief that the CAM provider and the politician are right.

    Putting people under more stress makes them desperate and more susceptible to demagogues that promise them miracle cures or miracle economic recovery or miracle restoration of “honor”.

  94. nybgrus says:

    For those who misinterpreted my original post because of sloppy reading, I even clarified the point on two separate occasions in two different ways.
    No matter. THE LIE continues. The clarifications are lost in the thread.

    I quoted you. I explained where you could have clarified. Now, let’s restart for a minute.

    Lets assume you did not accuse the authorship here of ties to big pharma. Now lets assume that the authorship agrees such ties are indeed bad and would say so to their colleagues. Now lets state that this blog is not about big pharma ties alone or primarily. Are you satisfied with that, Libby?

    If not, then what is it, exactly, that you are seeking? What is your argument. Explain it clearly and succintly, brand new and refreshed. Write a few clear paragraphs as though the previous thread never happened and explain what your beef is and what you think should be done about it and how that relates to this blog.

    Now is your chance Libby.

  95. libby says:

    weing:

    “You forgot to add how libby functions (pharma is bad, homeopathy is good, science is no good unless it gives me the answers I want). All you had to do was to look in the mirror to see propaganda in action.”

    I agree with you. If I had made any of those statements, and if I had repeated them numerous times, that would be propaganda. But I didn’t.

    When I say there are problems within pharma, you hear “bad”. When I say homeopathy has worked for me but not always, and that homeopaths should be better trained, you hear “good”. When I don’t even qualify science as good or bad, you hear “bad”.

    When I was talking about the depressingly low intellectual level on this board, this is the kind of post I was talking about.

  96. weing says:

    Let’s add this to your mantras.

    “When I was talking about the depressingly low intellectual level on this board, this is the kind of post I was talking about.”

  97. libby says:

    daedalus2u:

    I agree with much of your post, except for a few specifics such as how HH engages in argument. She essentially uses the straw man technique of misinterpreting a statement and attacking the misinterpretation.

    Nonetheless we can disagree on that.

    I’m intrigued you would laud Ronald Reagan and his view of “trust but verify.” I don’t see this as a terribly profound concept but in fairness to him, it didn’t hurt to say.

    However this is also the man who said that, “Trees cause more pollution than cars do.”

  98. libby says:

    weing:

    Speaking of intellectual level, you are the one who claimed that doctors can’t organize in support of SLA because of anti-trust laws.

    WHAT???

    Anti-trust laws having nothing to do with the act of doctors organizing to make a unified statement on policy, but the laws could be invoked if independent doctors (i.e. not attached to hospitals, etc) organize to FIX PRICES ON TREATMENTS.

    You’re a doctor and don’t even know how anti-trust laws apply to your own profession, and that your own 1st Amendment (not mine) protects the “right to assemble”.

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