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 a monoclonal 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.