Tuesday, May 08, 2018

How does a Cambridge professor of psychiatry get away with this?

As a young doctor, Ed Bullmore did not want senior physicians to start thinking he was bonkers, but now he’s long in the tooth it doesn’t seem to matter. He’s written what his publisher calls a “game-changing book” on depression (see book website).

Bullmore reminds me of Henry Cotton (1876-1933), an eminent and notorious American psychiatrist, who believed that the cause of mental illness was the systemic effects of largely hidden chronic infections (see my book review). This is because Bullmore has the same enthusiasm for so-called scientific medicine and advises depressed patients to ask their doctor to consider whether there may be a low-grade inflammation causing their depression. For example, he suggests trying a new dentist in case periodontitis (gum disease) has been missed. You might think this advice may well get him into trouble with the GMC. But, at least Bullmore doesn’t advise removal of teeth or tonsils or even the colon, like Cotton.

To give Bullmore his due, he does admit that finding periodonitis will not immediately make much difference to the treatment of depression. But, he is seriously asking us to consider his theory, which is actually about inflammation in general not just periodonitis, if only, because he is currently leading an academic-industrial partnership, whilst working part-time for a pharmaceutical company, to develop anti-inflammatory drugs to treat depression (see Neil MacFarlane’s review). Initially Bullmore wants to use these drugs for depressed patients that also have a physical illness and then for those depressed patients with raised inflammatory markers.

Don’t be confused into thinking that Bullmore is quite the critical psychiatrist. True, he doesn’t believe in the serotonin theory of depression. His history of the origin of antidepressants with Nathan Kline is actually quite good, although he doesn’t mention Roland Kuhn (see previous post). But, then he takes the radical step of saying that “rheumatoid arthritis is not primarily a disease of the joints” (Loc 963). This does sound bonkers, and what he means is that it is instead a disorder of the immune system. By analogy, we’re not really supposed to view depression as a psychological disorder, but as an inflammatory disease.

I’ve already said in a previous post that this hypothesis doesn’t make much sense. To me, Bullmore seems to compound this situation by confusing feeling sick with feeling depressed. He mentions several times that he had a root-canal filling at the dentist in 2013, and this made him feel blue. The link between inflammation and sickness cannot be disputed, but that inflammation causes depression is just plain wrong and not worth investigating any further. I just think Bullmore, like others, wants to develop an antibody for depression because anti-TNF antibodies for autoimmune and immune-mediated diseases have made billions of dollars over the years. This is despite the only trial of a TNF inhibitor in depression being negative. Bullmore should be put out of his misery.

Also, don’t think Bullmore is a good philosopher because he makes much of Descartes. Sceptics of his theory like me are dismissed as Cartesian, which I’m not. And he doesn’t spell out that his position is reductionist (eg. see previous post). True, he admits he likes such a point of view because it’s simpler. But I’ve made a point in this blog of emphasising that it’s important to integrate mind and brain (eg. see previous post) and medicine and psychiatry (see eg. another previous post). Bullmore could also learn from the philosophy of biology (see previous post).

Let’s conclude with quotes from Bullmore himself, “[I]mmunology has made no difference whatsoever to any patients with depression, psychosis or Alzheimer’s disease” (Loc 443). Nor should it! As Bullmore also says, “Voltaire and Molière filled theatres with their dark comedies about medical buffoonery” (Loc 1243). Bullmore is laying himself open to similar treatment from a modern satirist.


Karqa said...

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Richard Gipps said...

I wasn't sure about this bit: "To me, Bullmore seems to compound this situation by confusing feeling sick with feeling depressed. He mentions several times that he had a root-canal filling at the dentist in 2013, and this made him feel blue. The link between inflammation and sickness cannot be disputed, but that inflammation causes depression is just plain wrong and not worth investigating any further." Having felt the different feelings of sickness (feeling poorly/ill) and depression (feeling low/hopeless) in my time, I can testify that in my experience the prodrome to a regular cold always feels like depression and not like sickness. It feels like the times in my life when I've been depressed for far longer (without seeming to be ill). In fact I typically take myself to have become depressed for unknown reasons only to realise, when the cold breaks a day or two later and I finally feel sick, to my great relief that I'm actually just a bit poorly. Now I've no idea if the precursor stages to the cold involve inflammation, but the idea seems not far-fetched.

Anonymous said...

Duncan - would he have been given ethics approval to start this research at Cambridge? Many of us wonder how other so called academics get away with their nonsense which can only happen with the (mis)use of people being used as fodder for the 'bonkers' to experiment on . So often off the wall 'treatments' have caused great harm to people who do not have the information or any reliable information to enable them to make a decision to consent to them. Presently the refusal to accept the degree of harm being caused by legally prescribed psychiatric drugs is holding up research into finding the causes and hopefully cures for those who are suffering serious often long term even life long adverse effects of prescribed drugs. No pharmaceutical company is willing to look into the damage their industry, together with GPs and psychiatrists, is creating. A paper has been published on the Rxisk Blog by Professor David Healy and colleagues from Bangor University which documents in detail 600 cases of the thousands of people who have reported being damaged by drugs. It is published in the International Journal of Risk and Safety in Medicine. For free access see Rxisk Blog. The research team at Rxisk is being cloud funded in an attempt to find causes and cures.If only it was seen to be in the interests of psychiatry general practice and drug companies to contribute towards the fund - never mind as a matter of conscience, ethics...Wonder how much 'bonkers' Bullmore is getting? susanne

drnmblog said...

Good to have Duncan's historical knowledge taking us back to Scull's book on Henry Cotton and colonectomy. He (Duncan) doesn't seem to have written on colonic irrigation ('colon hydrotherapy') on his main Blog...maybe elsewhere?

For those who weren't tempted to go to my 30th April review (link in 3rd paragraph, above) before 8th May, I have now added comments on it from Oliver James ('excellent review - most illuminating') at the top and Nikolas Rose ('...I did enjoy your incisive review') at the bottom: https://drnmblog.wordpress.com/2018/04/30/the-inflamed-mind-by-ed-bullmore-book-review/

Anonymous said...

Apologies for my error above - I should have written 300 cases not 600. Thanks Susanne

JOHN T. SHEA said...

Interesting! A lot of critics of psychiatry like the inflammation theory, while psych-critic turned biopsychiatrical stormtrooper Dr. E. Fuller Torrey favours the infection theory. Torrey also blames cats...

Huwtube said...

Following Richard Gipps' point, it doesn't seem implausible that some instances of depression could result from inflammation. It does seem implausible that all instances of depression would result from inflammation. Perhaps this is why you're so skeptical about Bullmore's thesis. But what really is the scope of his idea? The way it comes over on the book's website, we'd be forgiven for thinking it's supposed to be a new total theory of depression, but this may be a problem of language. When someone says something like "depression" we're in the habit of thinking they mean "all instances of depression." Any theory with that sort of ambition should make us feel skeptical. But if Bullmore really just wants to talk about some instances of depression, his idea is probably not as preposterous as this post makes it seem.

Duncan Double said...

I'm sorry if I didn't make as much of Ed Bullmore's anecdote about his root-canal filling as a couple of commentators on my review. Of course such serendipitous association of ideas is the stuff of advances in science. I just want to emphasise, though, that my argument against Bullmore's theory is not just satirical, as I linked to a previous post that did briefly discuss the evidence.