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Nederlog


  March 9, 2013

Meditations on the corruption of psychiatry and medicine
"Préjugé, vanité, calcul, voilà ce qui gouverne le monde. Celui qui ne connait pour règle de sa conduite que raison, vérité, sentiment, n'a presque rien de commun avec la société. C'est en lui-même qu'il doit chercher et trouver presque tout son bonheur."

"L'honnête homme, détrompé des toutes les illusions, est l'homme par excellence."
-- Chamfort











Sections

Introduction   
1. Fraud in (medical) science
2
. Jaspers, brain diseases and nazis
3.
Data transparency and honest science
About ME/CFS

Introduction:

I keep having sore eyes and sleeping too little, for which reason there was no Nederlog yesterday.

Today I take up a number of recent posts on 1 boring old man. He is in fact a sensible psychiatrist in his seventies who is not at all boring, at least if you know some about psychiatry, psychology or medicine.

His blog/website is here:

and in the following three sections I take up some points in three of his recent blogs. In each case, I will provide a link to the blog and quote what I want to discuss, and I remark right at the start that in each case I select a point or two from a more comprehensive discussion

1. Fraud in (medical) science

This is from

  • f.r.a.u.d. is never right...   [1]

which is much appreciated by me because it poses the issue as I think is morally, medically and judicially correct: There have been massive frauds perpetrated by the leading pharmaceutical industries, frauds that are literally worth billions of dollars, and they have been perpetrated by three basic means - and what follows are my words and ideas (based on work done by others that I read):

  1. Secret, falsified, repressed and ghostwritten data about the experiments that are supposed to give pharmaceutical companies legal permissions to sell drugs as medicines that are fit for certain purpose: It has turned out that the main anti-depressants, and also other drugs, have been allowed as such and sold as such, to the tune of billions of dollars of profit, because the data and experiments to do so had been falsely reported, was repressed, or was ghostwritten by PR-specialists.
  2. Psychiatrists (and other medical doctors) have been willing to act as shills, con men, deceivers and liars, and have been moved to do so because they profited from this, by direct payments, percentages, or perqs. Moreover, especially American psychiatry has effectively sold out its medical morality to Big Pharma: Its diagnostic manual DSM is designed to help sell drugs by phony diagnoses that have no scientific basis whatsoever, and that have been concocted from medicalese by PR-specialists in medical conmanship.
  3. Psychiatry has been turned into a pseudoscience that is being defended, worded and sold by PR-specialist for PR-reasons: It is not an attempted real science driven by real scientists interested in finding the truth and helping ill people, but a sham, a hoax designed to sell drugs to naive patients in the name of a science, that in real fact is mostly PR prose designed to sell drugs and illusions to patients while keeping the perpetrators safe and pretending that what they offer is real medicine.

At least... that's what I have concluded after some 3 years of studies in psychiatry-related subjects, the reasons for which and the results of which you can find in my dsm-series.

The reason why "fraud" is the appropriate term for what pharmaceutical companies and psychiatrists have been doing the last thirty three years or so has been argued by me here - with a quotation from Wikipedia as to what fraud is in US law  - and I quote Wikipedia on the subject:

In the United States, common law recognizes nine elements constituting fraud:

  1. a representation of an existing fact;
  2. its materiality;
  3. its falsity;
  4. the speaker's knowledge of its falsity;
  5. the speaker's intent that it shall be acted upon by the plaintiff;
  6. the plaintiff's ignorance of its falsity;
  7. the plaintiff's reliance on the truth of the representation;
  8. the plaintiff's right to rely upon it; and
  9. consequent damages suffered by the plaintiff.

If you knowingly sell things that are not what you sell them for, to people who are not in a position to be able to know this, you are defrauding them, which is especially serious in the case of medicines and of medical men and women because these are so important to so many, so profitable if falsely and deceptively marketed, often so dangerous if not what they are sold as, and so difficult to discover for patients, because medicine and pharmacology are difficult sciences, that ought to be practised by honest and moral men, especially if its practice is profitable for them (which, as the world is, cannot be avoided, and is not bad in itself: it is being a medical man or selling medical drugs on false pretenses that is bad in itself - and see my Crisis + DSM-5: It's deregulation, stupid!).

1BOM discusses and quotes an article on Pharmalot that discusses the tricky approach "Big Pharma" recently has taken in response to revelations that much of the research they presented to legalize the sales of their drugs as medicines was tricked, biased, flawed, ghostwritten and dishonest:

Roche has tried to take every road around true data transparency imaginable, and I think that the general suspicion [mine at least] is that if the database is exposed and examined by independent scientists, the drug will not live up to its advertised expectations and the countries that stockpiled it are going to be pretty damned angry. The name for this kind of behavior is f·r·a·u·d.

We don’t use the word f·r·a·u·d very much when we talk about the Clinical Trials, or the jury-rigged articles, or the withheld studies, or the fantastic ad campaigns. Even in a lot of the judgements, they talk about false-advertising and off-label promotion, but it’s all simply f·r·a·u·d. And it looks like the Roche people have dug themselves a deep hole, one that’s growing deeper by the minute. And many in the pharmaceutical industry in general seem to be trying to make a case that they have a right to maintain their ability to continue to use f·r·a·u·d in their future drug marketing campaigns.

In my simple way of seeing things, the authors of these f·r·a·u·d·ulent articles are also committing f·r·a·u·d. Either they have seen the primary data, or should have. Either they know the protocols and the primary outcome variables, or they should have. Either they have checked the stats, the tables, or the graphs, or they should have.

I agree, and my main reason to agree and to have insisted myself that what the pharmaceutical companies and the American Psychiatric Association have been doing and writing indeed is fraud is that it happens in the name of medical science and in the name of medicine.

These are not just persons who advertise some miracle cure: These are persons who dangle their MD degrees, their white coats, their stethoscopes and their Ph.D. degrees in front of the noses of patients, judges and laymen to suggest that these are the proofs of their claims, their morality and their trustworthiness - while the "scientific studies" that allowed them to make millions by selling expensive drugs were not scientific studies but were exercises in ghostwritten lies that were expressly designed to make the bad, false and fraudulent seem good, medical and moral.

2. Jaspers, brain diseases and nazis

This is from

that discusses the ideas of Emil Kraepelin, Karl Jaspers and Sigmund Freud. 1BOM here cites an article about Jaspers and then continues himself as quoted (starting at "When I began"):

Apart from general paresis, Jaspers argues, “there has been no fulfillment of the hope that clinical observation of psychic phenomena, of the life-history and of the outcome might yield characteristic groupings which would subsequently be confirmed in the cerebral findings”. “The idea of the disease-entity is in truth an idea in Kant’s sense of the world”. Even in the cases of schizophrenia and manic-depressive illness, “one is always confined to types”, that is, “fictitious constructs which in reality have fluid boundaries”….

When I began in psychiatry, that’s what I thought and still think. Without really realizing it was happening, I had become more interested in the sick people than the medical diseases that made them sick, and had been drawn to learn more. If I had thought that the mental illnesses were brain diseases, I would’ve happily stayed in Internal Medicine. When I got to psychiatry and encountered the major psychiatric illnesses like Schizophrenia and Melancholia, I will admit that even in those dire conditions [which I assume are biological], I remained more interested in the afflicted than their afflictions.

I think that is a respectable motive to study psychiatry and to want to become a psychiatrist, but there is a confusion about "brain diseases" that both 1BOM, other psychiatrists and the APA are prone to, that also manifests itself in APA-prose by extremely pretentious vague phraseology like "mind-body duality".

The point is that, as fast as science is concerned, human beings do their thinking, desiring, feeling and experiencing with a living brain in a living body, for which reason the brain indeed must be the organ psychiatry is foremost concerned with, if it is to be a medical science rather than a theology of the soul.

The confusion is that this fact - that you think and feel with your brain - does not settle anything about the causality of what and why and how you think and feel:

If you are having problems as a person, and your conscious experiences are frightening, you feel depressed, you are continuously angry or nervous, or what not, your brain generates these experiences of yours in ways no cognitive scientist has so far  unriddled, and the causes that make your brain generate this may be very many and may not start in the brain: You may be drunk, you may have slept too   little for a long time, someone may have mixed mescaline in your coffee, you parents were very ill-equipped to raise children, your genes may make you susceptible to lead in the air, you may be allergic to things you don't know you are allergic to, you may have been living under too many pressures from too little money, you have been eating poisonous mushrooms, you are not a rational person at all, you are prone to being emotional when you should not - any selection of these may be (part of) "the cause" of your problems, indeed just as when you car malfunctions: the exhaust pipe may be stuffed, someone may have thrown sugar in the fuel tank, there may be no fuel in the tank, some crook stole the battery, or perhaps the dear Lord is trying to prevent you to twist the key that will blast the bomb an enemy has planted under your car.

And in the end a psychiatrist treats human persons, and neither the psychiatrist nor his patients has any good rational idea about how the patient's or psychiatrist's brains generate the experiences they have, or for what reasons, from what causes, even if indeed the scientific medical starting point to explain experiences is that the
brain generates them - but how and why and depending on what relevant factors no one really knows.

1BOM continues the above thus:

But what I do ponder is how this particular scientific revolution in psychiatry in 1980 gave rise to such a widespread level of corruption in both individuals and institutions.

My own guess is that there were various causes, but the DSM-III is a very important part of it: This showed that what was effectively unscientific labelling in pretentious medicalese terms, and not really different from PR [2], could be sold as if it were real medical science - which probably surprised the APA, who had little better than loads of dishonest and fraudulent PR [2] after several decades on onslaughts by philosophers of science, literary critics, authors, pscyhologists, anti-psychiatrists and others on Freudian psychiatry and its offshoots, that also had intellectually mostly destroyed it and showed it up as little better than illusions and/or false promises, if perhaps, as with the priesthood and the clergy, at that time often mostly sincere.

I also think that the real cause is multiple and complex, and that part of the reason this fraudulence was so widely accepted was that it was sold so well, by very effective PR, that was for the first time in psychiatry consciously adopted as sales technique of both psychiatry and psychotropic drugs: See

for a long interesting documentary on the many crisscrosses and overlappings of psychiatry and public relations, both of which were started by the Freud family, and since then continued by subsequent generations of that family, now also related by marriage to such modern masters of PR as Rupert Murdoch. [3]

1BOM then continues the above thus:

Jaspers turned to philosophy after World War I, warning about existential despair and the threats to individuals in the face of ideology, scientific technology, and political institutions. He then had to live through the worst perversion of those very things the world has ever known, Hitler’s Germany, kept in place by a powerful German industrial complex. One must always be careful about analogizing anything to the Nazis, such an easy place for exaggeration, but the massive intrusion of industry into the field of psychiatry does touch a similar point. Much of the psychiatric literature that followed our scientific revolution and open commitment to evidence-based medicine will stand in history as a testament to a perversion of those very principles in the service of commercial goals. Jaspers felt that all of German Society was culpable for the Nazi atrocities. I think he would similarly hold the whole of psychiatry responsible for the many misadventures of the last thirty years.

I have three remarks about this.

First, the Nazis, like Stalin and his followers, and Mao and his followers, were all human-all-too-human (in Nietzsche's phrase): These totalitarian regimes show that conformism, hypocrisy, totalitarianism, and the "video meliora proboque; deteriora sequor" mentality are very ordinary among men of all kinds and all levels of educational attainnment.

The pretension - "o, that's just a Godwin!" - this is not so is in fact the pretension that Nazism, Stalinism and Maoism are extra-ordinary and followed by few, while the bitter truth is that many hundreds of millions of human beings sincerely believed and practised these inhumane doctrines.

It's true that what can be used can be abused, and that many references to Nazism, and Stalinism and Maoism, are caused by anger rather than by relevant knowledge, but it's also true that these three social systems and moral and philosophical teachings, for that is what they were and are, show how very easy it is for human beings to follow what is effectively the inhumane path, and to do so in the name of the highest moral ideals, indeed precisely as what seems to have happened with postmodern psychiatry: corrupted by power, greed, human weakness, and dishonesty for personal advantage.

Second, while I believe "evidence based medicine" is a PR-term [4], I agree that it seems as if psychiatry, at least since the 1980ies, as practised by the leading echelons of the APA, and as enshrined in the pseudo-scientific DSMs, are wilfull perversions of real science, and of scientific methodology.

Third, it's a bit difficult to say whether "the whole of psychiatry responsible for the many misadventures of the last thirty years", and the situation is not quite analogous to holding " all of German Society was culpable for the Nazi atrocities" - which in fact is false and is either uninformed or dishonest.

To start with the last point: While many ordinary Germans embraced Nazism or collaborated with it while it lasted, it is false that "all of German Society" did so: From 1933 onwards, many Communists and Socialists and Anarchists and Social Democrats, and soon also quite a few Christians, and later very many Jews, found themselves locked up in concentration camps, like Dachau, Sachsenhausen and Buchenwald, where many eventually were murdered.

Hence: Not all Germans were guilty of Nazism, since quite a large group resisted from the very beginning, and indeed was mostly exterminated by 1945.

I turn to the question whether "the whole of psychiatry" is "responsible for the many misadventures of the last thirty years", and start with noting there are at least two relevant differences between psychiatrists and "all of German Society".

The first point of difference is that psychiatrists are all highly educated, and all are medical men or women, who in their capacity of medical persons both have and pretend a moral responsibility to their (potential) patients and to the rest of society, that has had no medical training.

The second point of difference is that, unlike most, though by no means all, of Hitler's doings, much of what went into the DSMs and what happened in and motivated the leaderships of the APA these last three decades, happened in secrecy and was subject to many deceptions (of: the public at large, the FDA, the medical community, and many psychiatrists who naively believed their leaders meant well and behaved, wrote and thought like real medical scientists).

I tend to infer from this that not all US psychiatrists were culpable for the doings of the APA and the phony bullshit that is the main fare in the DSMs. Indeed, some opposed the APA for a long time, for various reasons, of various intellectual and moral qualities.

I also tend to infer from this that - especially but not only - US psychiatrists are culpable in principle to a considerable extent, precisely because - as I said earlier also - they are medical men and women, who are highly educated, and who should know what is and is not real science, and when an argument is PR (as most of the arguments that went into the DSM) rather than an attempt to do psychiatry in an honest scientific, empirical and rational way. Indeed, if psychiatrists are not capable of keeping their own science from being corrupted by greed, dishonesty, deception and propaganda, who should and who could?

So in sum I am in two minds about this issue of responsibility, and my general orientation is that while it will depend a lot on the persons, as a professional group psychiatrists, and especially those who were its prominent US spokespersons the last two decades, carry a lot of responsibility for betraying the interests of their patients and of society, for getting financially a lot better from that betrayal themselves, as indeed was (and is) the case with Benda's "la trahison des clercs", that is, the betrayals of the intellectuals to the powers of totalitarianism, industry, pharmacology or banking.

3. Data transparency and honest science

This is from

that discusses an article by Peter Gøtzsche in the British Medical Journal, mostly but not only on the subject of data transparancy.

After quoting Peter Gøtzsche 1BOM remarks (and "GSK" is GlaxoSmithKline, the very honorable men behind this amazing video):

Ben Goldacre [AllTrials], Fiona Godlee [BMJ], and the Peter Gøtzsche [Nordic Cochrane Group] seem to be in a fairly intense cat and mouse game with Roche, GSK, and by proxy everything PHARMA over the meaning of the term data transparency. They mean "all of it" – the protocols, the raw data reports, everything the people doing the study have the opportunity to see themselves – including the data for studies not slated for publication – including the studies going back for thirty years. While it seems a bold request, the behavior of the pharmaceutical companies has been so regularly egregious that complete data transparency has moved from the level of a request to a requirement. At least in psychiatry, it would be unethical to practice just relying on the kind of information that has been available to us in the last several decades now that we know how far off the mark it has actually been – both in terms of efficacy and adverse effects, particularly the latter.

Of course, "it would be unethical to practice just relying on the kind of information that has been available to us in the last several decades now that we know how far off the mark it has actually been – both in terms of efficacy and adverse effects, particularly the latter", and of course "peer reviewers" only can do their work well and in a rational fashion if they get access to everything that is relevant, and not just those parts of the findings that would move them to conclusions pharmaceutical companies are interested in.

There is no honest science and there is no real attempt to find the truth if what one gets offered as "scientific publication" are only those parts of research that serve the financial interests of the makers of medical drugs. Again that is nothing other than fraud and nothing better than pseudoscience.

1BOM continues the above as follows:

There is little question that these measures will negatively impact the profitability of pharmaceuticals, but those are clearly ill-gotten gains. The only rational alternative would be to dramatically tighten the FDA/EMA approval processes. And it seems a better solution for medicine itself to assertively assume the watchdog role. Medical ethics are neither the domain of pharmaceutical companies nor the government. That contract needs to be between physicians and patients. If we physicians are to be the gatekeepers and the dispensers of medications, then it’s our collective responsibility to do the checking so we know what we’re talking about. We can’t do that without access to those raw data sets.

I quite agree, and indeed it would be very good to see more physicians stand up and demand that medical science is done in an honest, responsible, forthright way, and without secrecy, manipulation, falsification, ghostwriting, or steered by PR financed from the bank vaults of big pharmacy, with the intent of putting the most profitable and best appearance on all things that serve the financial interests of Big Pharma, while screwing the ignorant patient population every year out of billions for ill researched and falsely reported often dangerous and regularly ineffective but extremely profitable medical drugs.

P.S. March 16, 2013: I corrected some typos and added some links.

----------------------------------
Notes

[1] The link of this on 1 boring old man is in fact to the article I discuss in section 3, so to read the article you have to go to 1 boring old man dated March 5, 2013.

[2] PR=Public Relations-=the art of propaganda, lying and professional conmanship. I quote from Wikipedia on public relations
The aim of public relations by a company often is to persuade the public, investors, partners, employees, and other stakeholders to maintain a certain point of view about it, its leadership, products, or of political decisions.
[3] The wife of Freud's grandson Michael Freud, the owner of a large British PR-firm, is a daughter of Rupert Murdoch; Freud's own double nephew Edward Bernays started the conman bussiness of PR, then called "propaganda", with help from his uncle Sigmund's advice; Freud's daughter Anna had much influence on the US government's "mental health" policies; the whole modern science of marketing and focus groups was the brain child of psychiatrists in the Freudian tradition, working for PR-firms of the Bernays kind.

[4] It's a tautology: medical teachings that are not "evidence-based" are not medical science but superstittion. If you insist that so and so is "an evidence-based science" you protest too much, and strongly suggest you say so because you know that what you are plugging in fact is neither a science nor evidence-based.
There is no science without evidence.


About ME/CF
(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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