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Nederlog

January 18, 2013


Diederik Stapel, the DSM-5 and medical and scientific fraud

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Introduction   
1.
Diederik Stapel, the DSM-5 and medical and scientific fraud
About ME/CFS



Introduction:

There is an earlier Nederlog of today, on strange disappearances at X Rx Blog, and specifically of a text I wrote about and quoted. The present Nederlog takes up the theme of Diederik Stapel's fraud again, and tries to put it in a wider perspective - that I can do because, unlike almost everyone who writes about the Stapel case, I have definitely acquired rather a lot of expertise on scientific fraudulence the last few years, and not because of Diederik Stapel, but because of the DSM-5.

1. Diederik Stapel, the DSM-5 and medical and scientific fraud

Let me first get some of the background straight. The last Nederlog on Diederik Stapel's case was last year, on December 24, mostly in Dutch, because I realized I had not done so before, and had a reason to, but then this also gives links to the other Nederlogs I wrote about his case, with an English introduction:

I now take the background as known, and found today that Neuroskeptic discusses the case, with reference to another Brit who wrote about the Stapel case. Here are the links:

The second is the article the first links to and discusses. Also, those who do know the background probably recall and realize that

And now the relevant background has been mentioned and linked, and I can discuss Neuroskeptic's discussion of Shank, that starts as follows
Lots of people are chipping in on this debate for the first time at the moment, but peoples' initial reactions often fall prey to misunderstandings that can stand in the way of meaningful reform - misunderstandings that more considered analysis has exposed.

For example, Shanks writes:

[despite claims that] social psychology is no more prone to fraud than any other discipline, but outright fraud is not the major problem: the biggest concern is sloppy research practice, such as running several experiments and only reporting the ones that work.
It's true that fraud is not the major issue, as I and many others have said. But bad practice, such as p-value fishing, is in no way "sloppy" as Shanks says. Running multiple experiments to get a positive results is a sensible and effective strategy for getting positive results; that's why so many people do it. And so long as scientists are required to get such findings to get publications and grants, it will continue.
I agree with the initial paragraph, but only half with the rest - and my argument might come unexpected to persons like Neuroskeptic and Shanks, who simply don't have my background.

But let's start with the term "sloppy research" that is the meanwhile accepted English translation of the Dutch euphemistic neologism introduced by the Levelt Committee: "slodderwetenschap".


As I have explained before, I prefer "bad science", (1) because "sloppy research" is too vague and imprecise, though I agree with Levelt that there is a lot of it in Holland, and (2) because in Stapel's case it was not so much sloppy science as clever fraudulence, and that may be the case with other scientific frauds as well, though it is true that if their - so called - peer reviewers are sloppy or bad scientists, that may result in the acceptance of what is in fact fraudulent science as if it were real science. And it is true that this may be the case in social psychology: If one of its reputed lights turns out to have been able to get published over 50 frauds in that field, possibly in a period of 15 years duration, the necessary checks and balances seem not to have worked or not to have been present, except in name.


Now to Neuroskeptic's point that

"bad practice, such as p-value fishing, is in no way "sloppy" as Shanks says. Running multiple experiments to get a positive results is a sensible and effective strategy for getting positive results; that's why so many people do it."
That is at most half valid. First, while it is true that - maybe - "everybody does it", the first problem is that if negative results are not reported, while the positive ones are, in fact what happens is that one's experiments get falsely reported - and not that the difference may be between "I got this stunning experimental statistical proof that X" and "but I 'just forgot' to mention the 13 previous experiments were all non-significant ".

The second problem is far more serious, though it is less applicable to social psychology: It has turned out that pharmaceutical companies run experiments on drugs until they have two positive studies that support their contentions, which is what the American FDA requires for its approval - while the companies systematically leave out mentioning the negative results, and indeed also commit what is in fact
fraud on a major and often repeated scale.

This got discussed by professor Healy, whose person, site and video I mentioned in my

Here are two views he presents, on research on anti-depressant drugs:

The first is what the pharmaceutical companies like one to believe, especially if one is a doctor with powers of prescribing the drugs mentioned, and is what gets published in medical journals, and what forms the "evidence-based" "scientific" justification for prescriptions by psychiatrists and medical doctors to millions of patients:


Clicking the image starts the lecture

As you'll see, in the medical journals, most of the anti-depressant drugs, that turn over tens or hundreds of billions of dollars each year, in the US alone, that are mostly profits, have rather a lot quite positive supporting "scientific research" going for them.


However, if one can look behind the scenes, and does so, matters are not quite so positive as depicted above: Here some of the negative findings are added to the graphic:



Clicking the image starts the lecture

Same drugs, "same research", same ruling that the pharmaceutical companies need, in principle, to submit only two "positive studies" to the FDA in order to be allowed to market the drugs with such positive, and need not report on any of their negative findings.

In fact, it is likely some of my readers may be taking or may have taken some of these pills. In case you worry, you are right to do so, as you can verify on the following interesting site, made by an American psychiatrist in his seventies
:
There is a lot to check out there, if you are interested in psychiatry, medicine, fraudulent publishing in science, or in the dangers of antidepressants that the makers of anti-depressants wanted to keep secret, not in the interest of your health, but in the interest of their profits, and it will not contribute to your happiness, especially if you took or take Prozac, Zoloft or other anti-depressants:

These drugs indeed may help you, but then again they may not help you, for "the evidence" that they do is partial and tricky, and not quite what the pharmaceutical companies have claimed it to be e.g. in the cases of Prozac or Paxil or Zoloft - and these anti-depressants also may make you feel suicidal or violent, for the evidence that this is so, in quite a few cases, was systematically ignored, repressed and denied. And besides, there has been no really adequate research into the question how dangerous these drugs are when one takes them a long time, as tends to be the case with anti-depressants.

That's
another kind and quality of fraud than was committed by Diederik Stapel, and to get the difference clear, here are two assumption I shall make, that apply to much more than publishing in scientific journals, fraudulently or not:
  1. Wherever human beings can improve their status, power, or income, they will tend to try to do so, also if the means to achieve the end are dishonest, immoral, fraudulent or illegal.
  2. The incitement to use dishonest, immoral, fraudulent or illegal means to advance oneself are roughly proportional to the advantages that are expected from using such means.
The advantages for Diederik Stapel must have been - apart from the kick of doing it, that I shall not consider - mostly in gaining personal status: He may have committed fraud to publish the papers that made him a professor (which I don't know), but if so, he then could have stopped, and remained a well-paid but not a well-known professor, in a "science" that has not much status, but that would have given himself and his family an easy, well-paid life, in one of the highest social functions (tenured professor in a university).

His frauds made him appear to be a major success; got him repeatedly on national television; and gave him considerably more status and almost certainly therefore also more power among colleagues and in Dutch universities. Apart from possibly  - I don't know - obtaining a doctorate (since returned by him) and a position as professor by fraud, Stapel probably did
not profit much financially, and indeed he may have gotten either or both social advantages by honest means as well.

Thus, Stapel's many frauds - more than 50 so far, and still counting, it seems - benefited him in providing some status and power, and possibly some financial advantage, but the main point of doing it - apart from the kick - must have been the increased status as a nationally well-known quite successful scientist.


Otherwise, he gained little, and also did not do much harm, apart from such harm as he did to his family, students,
colleagues who co-authored with him, and to the reputation of especially social psychology as an academic discipline. Also, he seems to have been using only one method: He made up the "data", that were supposed to be the empirical basis for his surprising results. [1]

It is
quite otherwise with the medical and psychiatric
fraudulence that professor Healy discusses - and to make this clear: In his talk that is linked above he speaks mostly about anti-depressants, and also speaks some about made up examples, that are meant to illustrate his case, e.g. that with the methods presently in use to "scientifically test" the purported anti-depresant properties of proposed drugs, meant to be eventually marketed at the yearly cost of billions to the public, of which a substantial part is profit for the drugs companies, alcoholic drugs (supposing alcohol was unknown) could be "scientifically proven" to be fine anti-depressants, compared to placebos, while it would not be found in these procedures, which need just two positive cases, and just 6 weeks of experimenting, that alcohol is addictive and unhealthy.

Let's first consider the methods of fraud. Professor Healy discusses the following five points in his lecture - and the bold phrases are his, while the non-bold brief explanations are mine:
  • Ghostwriting of studies:
    What seem to be papers by medical scientists of high reputation supporting a drug or drugs-involving therapy, in fact sometimes are ghostwritten by marketing experts, and were signed for money: deception.
  • Non-publication of studies:
    Studies that are done but do not show what the drugs companies want to make known - such as: studies that show an anti-depressant does not perform better than a placebo - are not published: falsification.
  • Miscoding of Data:
    Outcomes such as suicide or suicidal thoughts are reworded in reports of data found as other than that, e.g. as depression or nausea: lies.
  • Use of Statistics to Obscure:
    And also misrepresent or falsify, such as pooling the data of two non-significant studies into data that then give a formally significant outcome: dishonesty.
  • Lack of access of data:
    The raw data - like the data of studies that do not support what pharmaceutical companies like to see supported - are kept secret: In effect, one is supposed to trust that such data as one gets are a fair summary of representation of the raw data: fraudulence.
In other words, for drugs companies and indeed for psychiatrists, scientific fraudulence is a high art - and has been practised since the 1980ies, and especially since the reception and marketing of Prozac in 1990ies showed that the sky is the limit for pharmaceutical profits, since when the major drugs companies have been repeatedly "punished" by "settlements" with the legal authorities in the United States, but in fact always by amounts that fell far short of the profits they made by these frauds, while no one got personally prosecuted and punished. [2]

Second, let's consider the motive: Huge financial profits. Here is just one example, that underscores the point I just made - and I quote from "Breaking down GlaxoSmithKline's Billion-Dollar Wrongdoing":
The New York Times reports also that the fines represent a fraction of what Glaxo made from the drugs overall:

Avandia, for example, racked up $10.4 billion in sales, Paxil brought in $11.6 billion, and Wellbutrin sales were $5.9 billion during the years covered by the settlement, according to IMS Health, a data group that consults for drugmakers.

“So a $3 billion settlement for half a dozen drugs over 10 years can be rationalized as the cost of doing business,” [Patrick Burns, spokesman for the whistle-blower advocacy group Taxpayers Against Fraud] said.

The settlement covers improper Glaxo practices from the late-1990s to mid-2000s. Based on claims by whistle blowers — four Glaxo employees — prosecutors said the company tried to get doctors to prescribe drugs off-label by buying them spa treatments and lavish trips, and in the case of Paxil, helping to publish a paper in a medical journal that misreported clinical trial data.

Just adding up the totals for the sales of the three drugs mentioned gets one to almost
$ 28.000.000.000, which surely constitutes an excellent motive for dedicated, professional and long lasting fraudulence, on a truly industrial scale. 


This also explains what is behind the
DSM-5 - as I first concluded in July last year:
I list these to chart my own journey to my conclusion [3], that included looking in total disbelief at the utter crap that the DSM-5 editors wrote or endorsed and even writing this out for the frauds of the DSM-5 in 2011:
Here is my sum-up then - when I knew far less of the enormous profits and nothing of the sick scams perpetrated by psychiatrists working for the pharmacological companies:

A fraudulent manual of pseudo-science, meant to enrich psychiatrists, to make the "science" of psychiatry totally unfalsifiable under pretense of doing this for reasons of "evidence based science", and to make psychiatry capable of any form of bureaucratic of instutional abuse, and a major tool of denying very many people real medical help, by accusing them that they are mad, malingering, feigning - and who do it by lying, namely because those who lyingly, while feigning scientific knowledge, belong to a guild of medical frauds, who are in it for the money, for themselves, and for the institutions they serve.

The DSM-5 is a sick fraudulent schema of deception, that has little or nothing to do with real science, and everything with medical fraudulence.

It is high time non-psychiatric medical specialists come to their senses and realize that the interests of their patients are very badly served by a professional group that can manufacture this manner of pseudoscientific fraudulence and deception.

So... it may be assumed I will return to this, if I can. For the moment, there are  three  general conclusions:

1. While Diederik Stapel definitely perpetrated a major scientific
fraud, both as regards to what fraudulence has been discovered in science, and as regards its length and extent, it seems very small when compared to the enormous frauds that have been perpetrated by psychiatrists and doctors working for big pharmaceutical companies: He is an amateur compared to the pros frauding for the pharmaceutical companies, who also got much richer from it, while being at least as fraudulent, but in a craftier way.

2. The reason the fraudulence in medical science, and by pharmaceutical companies, and by psychiatrists, is not much discussed is presumably that (A) the pharmaceutical companies have a lot of money and very good PR (in fact, a lot of what they purport is "science" in fact is PR pretending to be science) and that (B) in effect, such prosecutions as have taken place have not prosecuted the people who commit the frauds, and consisted of financial settlements that amounted to a small percentage of the profits made by the
frauds.

3. Another reason, in addition to the excellent public relations - incidentally, the science of psychopaths: Check out Bernays's "Propaganda" - and lots of money to buy people's silence or assent on the part of the pharmaceutical companies, is that it concerns (what is claimed to be) medical science, where the public tends to believe medical doctors far more than doctors in other sciences, and where also the real facts of the matter are not easy to understand - and of course all critics will get fluently contradicted by very well-paid spokesmen for pharmaceutical companies, who also are "medical scientists" such as the professional shill and professor of psychiatry Charles Nemeroff.

---------------------------------------------------

Jan 19, 2013:
Corrected some typos and added some links.

Notes

[1] He suggested both he and his colleagues in psychology used other not really honest methods to get published in scientific journals, and he also suggested this was quite common, but he seems to have not been clear about this, while his own major success with frauds that got published as if they were real science seem to have all been based on data he made up.
[2] On this topic, see e.g.
Health Care Renewal's   The Tragic Case of Aaron Swartz: Unequal Justice for Web Activists vs Health Care Corporate Executives and also their Pfizer's Pfourteenth Settlement - a Small Reminder of Continuing Impunity  
[3] I mention this because I do my own thinking, and Nederlog is one report of that, but it is surely true that others noticed something was very wrong much sooner. Three examples are David Healy, mentioned above, and a psychiatrist; Gwen Olsen, mentioned repeatedly in Nederlog, and a former sales rep for drugs companies; and Suzy Chapman, an advocate for patients with ME/CFS, whose site first identified the problems with the DSM-5 for me.


About ME/CFS (that I prefer to call M.E.: The "/CFS" is added to facilitate search machines) which is a disease I have since 1.1.1979:
1. Anthony Komaroff

Ten discoveries about the biology of CFS(pdf)

2. Malcolm Hooper THE MENTAL HEALTH MOVEMENT:  
PERSECUTION OF PATIENTS?
3. Hillary Johnson

The Why  (currently not available)

4. Consensus (many M.D.s) Canadian Consensus Government Report on ME (pdf - version 2003)
5. Consensus (many M.D.s) Canadian Consensus Government Report on ME (pdf - version 2011)
6. Eleanor Stein

Clinical Guidelines for Psychiatrists (pdf)

7. William Clifford The Ethics of Belief
8. Malcolm Hooper Magical Medicine (pdf)
9.
Maarten Maartensz
Resources about ME/CFS
(more resources, by many)


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