Monday, March 11, 2019

Overstating the impact of psychiatric research

Medium has a new mental health publication - 'Inspire the Mind' - produced by the Stress, Psychiatry and Immunology (SPI) Lab at the Institute of Psychiatry, Psychology and Neuroscience at King’ College London led by Professor Carmine Pariante, who I have mentioned previously (eg. see previous post). It has reprinted 'Facts You Should Know About Psychiatry and Why It Is Helping the Person Next to You' from a HuffPost article, although it's dropped the reference to 29 facts we should know, I think because the booklet from the Royal College of Psychiatrists to which the original article refers no longer exists (if it was ever published). Maybe the College had second thoughts about making such 'scientific' claims (eg. see previous post).

It is important to encourage debate about the potential harm of recreational drugs and whether substitute prescribing of methadone leads to harm reduction, but Pariante seems to think it is clear that cannabis causes schizophrenia, which is not the case (see eg. previous post). Like him, I also agree the development of psychological therapies should be evidenced-based, but he doesn't describe the realities of the Improving Access to Psychological Therapies (IAPT) programme (see previous post), nor mention the evidence bias towards specific therapies, such as CBT, or even the problem of the adequacy of controls in evaluating psychological therapy (eg. see previous post). Nor am I sure where his apparently inflated figure of 80% recover for psychological therapy of panic disorder and social anxiety comes from. I doubt research is really needed to show that reducing the maximum pack size of over-the-counter sales of paracetamol, and limiting sale to one pack, reduces paracetamol overdoses (although has such research actually been done?). But Pariante needs to be more careful about making claims for the value of the National Confidential Inquiry into Suicide and Homicide in improving patient safety (eg. see previous post).

I do understand why Pariante wants to answer criticisms of psychiatry. He admits himself that the article is a "little bit of PR". But his attempt to create a positive view of psychiatry shouldn't lead to him unscientifically overstating his case.


F68.10 said...

"Pariante seems to think it is clear that cannabis causes schizophrenia, which is not the case"

The evidence for cannabis causing schizophrenia is lacking in some respect. And as any scientific claim in medicine and even more in psychiatry, that's hardly a surprise.

Before I take these "scientists" seriously, I want them to take me seriously and do the following: examine critically all of their cognitive biases, and weighing whether these biases impacts their claim.

I want to know exactly what the state or knowledge/belief is. If critical psychiatrist do this epistemological work themselves, they will be criticized without any clear evidence with the "you're biased" slur. So the onus is not on critical psychiatrist to defend or criticize the epistemology of this finding. The onus is on "mainstream" psychiatrists to fully expose what the epistemology of their claim is. There's no shame in doing that openly, (even if there are consequences for society).

Not holding my breath.

But as it is clear that there is motivated reasoning going on their part, it should be up to them to undertake that job.

While there likely is a complicated link between cannabis and "schizophrenia" (I'm using scare quotes for complicated reasons, but mainly because a rationalist I know, and not believe, that the map - i.e. diagnostic criteria are not the territory - i.e. what happens in reality.)

But here is a question for the skeptic community when it comes to the ethics of socratic epistemology: When A exhibits motivated reasoning, and B claims biases in A's position, can A dismiss B's claims of biases by not answering them and claiming in turn that B exhibits himself motivated reasoning? Or would it be more rational and ethical to first answer B's claims of bias and only subsequently, if A so wishes, claim motivated reasoning?

Because that currently is where the "debate" concerning cannabis and schizophrenia is at the current moment.

Moreover, there are many more issues in this debate to be addressed, but they cannot even be voiced currently, because A hasn't assessed B's claims of bias.

Engineered status quo in my opinion, that contributes to a health scare. And as we all know, and not believe: health scares have consequences who are not uniformly good, to put it mildly.

Any rationalist should understand what this is post is about. But alas, doctors are not rationalists. Far from it.

F68.10 said...

"He admits himself that the article is a "little bit of PR"."

Oh yeah. He admits that he is spouting bullsit.

Still waiting for Bullshit-free medicine.