Publication Bias: Does Unpublished Data Make Science Pseudo?

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Way back in the 1970s when I first started studying psychology I heard about publication bias. It was easier to get a study published if it had significant results than if it didn’t.

That made a certain amount of sense. A study producing only nonsignificant results (group against group, variable against variable, pretest versus post-test) might be badly designed, underpowered (too weak to detect a genuine effect), or simply misconceived. No wonder no one wanted to publish it. And who cares about hypotheses that turn out not to be true anyway?

Partly, of course, the problem is obvious: if positive studies are much more likely to be published than negative ones, then erroneous positive results will tend to live on forever rather than being discredited.

More recently the problem of publication bias has been shaking the foundations of much of psychology and medicine. In the field of pharmacology, the problem is worse, because the majority of outcome trials (on which medication approval and physician information is based) are conducted by pharmaceutical firms that stand to benefit enormously from positive results, and run the risk of enormous financial loss from negative ones. Numerous studies have found that positive results tend to be published, while negative ones are quietly tucked under the rug, as documented by Ben Goldacre in his excellent book Bad Pharma.

In a case examining outcome trials of antidepressants (Turner et al, 2008), 48 of 51 published studies were framed as being supportive of the drug being examined (meaning that the medication outperformed placebo). Of these, 11 were regarded by the US Food and Drug Administration as being questionable or negative but were framed as positive outcomes in publication.

So the published data look like this (P = positive, N = negative):

PPPPPPPPPPPPNPPPPPPPPPPPPNPPPPPPPPPPPPNPPPPPPPPPPPP

Given that a great number of readers only look at the study abstract or conclusion, or lack the skills to detect spin, they’ll miss the reality that many of the positive trials aren’t so positive. The real published data look more like this:

PPPPP?PP??PPNPP?PPPP?PPPPNPP??PPPP?PPPNPP?PPPP?PP?P

In contrast, only 1 of 23 unpublished studies supported the idea that the medication being tested was effective.

NNNNNNNNNNNNPNNNNNNNNNN

So the real picture is more like this:

NNPPPNPP?PNP??PPNPNP?PPNNPP?PNPPNPNNP

P??NPPNNNPPN?PPNPNPNP?PNNPPNP?PPN?PN

Given that physicians, who are urged to prescribe based on the research, only have access to published data, the result is likely to be a systematic exaggeration of drug benefits.

Smug psychologists (and others) have stood by smirking, unaware that their perspective is elevated only because they are being hoisted by their own petards. True, there are no billion-dollar fortunes to be made from a psychological theory or a therapeutic technique, but there remain more than enough influences to result in a publication bias for noncorporate research:

  • A belief (often justified) that journals are more likely to reject articles with nonsignificant results.
  • A tendency to research one’s own pet ideas, and a corresponding reluctance to trumpet their downfall.
  • A bias to attribute nonsignificant results to inadequate design rather than to the falsehood of one’s hypotheses.
  • Allegiance to a school of thought that promotes specific ideas (such as that cognitive behavior therapy is effective – one of my own pet beliefs) and a fear of opprobrium if one reports contrary data.

Does Publication Bias Fundamentally Violate the Principles of Science?

Although science can lead to discoveries of almost infinite complexity, science itself is based on a few relatively simple ideas.

  • If you dream up an interesting idea, test it out to see if it works.
  • Observation is more important than belief.
  • Once you’ve tested an idea, tell others so they can argue about what the data mean.
  • And so on.

Even science, in other words, isn’t rocket science. One would think that in execution it would be about as simple as in explanation. But no. In practice, it’s extremely easy for things to go wrong.

An early statistics instructor of mine showed our class an elementary problem with research design by discussing a study of telekinesis (the supposed ability to move things with the mind). The idea was to determine whether a talented subject could make someone else’s coin tosses to come up “heads.” As the likelihood of a properly balanced coin coming up heads is 50%, anything significantly above this would support the idea that something unusual was going on. And indeed, the results showed that the coin came up as heads more often than random chance would suggest. The instructor invited us to guess the problem in the study.

A convoluted discussion ensued in which we all tried to impress with our (extremely limited) understanding of statistics and research design – and with our guesses about the tricks the subject might have employed. Then the instructor revealed what the experimenters had done.

They knew that psychics reported sometimes having a hard time “tuning in” to a task. So if they used all of the trials in the experiment, they might bury a genuine phenomenon in random noise – like trying to estimate the accuracy of a batter in baseball when half the time he is blindfolded. Instead they looked for sequences in which the subject “became hot,” scoring more accurately than chance would allow, and marked out these series for analysis. Sure enough, when compared statistically to chance, there were more ‘heads’ than random chance could account for.

We stared at the instructor, disappointed that his example wasn’t a bit, well, less obvious. How could reasonably sane people have deluded themselves so easily? Clearly this little exercise would have nothing useful to teach us in future.

Try it yourself sometime. Flip a coin (or have someone else do so), and try to make it come up heads. One thing it will almost certainly not do is this:

HTHTHTHTHTHTHTHTHTHTHTHTHTHTHTHTHTHTHTHTHTHTHTHT.

Instead, you’ll get something like this (I just tried it and this is what I got):

TTTHTHTHTHHTTHTHTTTTHHHHTHHTTTHTHHHTTTHTTTTTTHHHHTTTHHHTHHTTTHHTHHHHTHHHTTTTHHHHHTHTTHHTHTTTTHHTHTHHHHTTHHTTHTTHHTHHHTTTHHTTTHT

Totals: Heads = 63; Tails = 64

Now imagine that you only analyze sequences of 6 or more where I seem to have been “hot” at producing heads.

TTTHTHTHTHHTTHTHTTTTHHHHTHHTTTHTHHHTTTHTTTTTTHHHHTTTHHHTHHTTTHHTHHHHTHHHTTTTHHHHHTHTTHHTHTTTTHHTHTHHHHTTHHTTHTTHHTHHHTTTHHTTTHT

Drop the rest of the trials, assuming that I must have been distracted during those ones, and analyze the “hot” sequences:

Heads: 43 Tails: 12

Et voila: Support for my nonexistent telekinetic skills.

Okay, so That Feels Belabored Because it is so Completely Obvious. Why Bother With it?

Well, let’s shift the focus from different periods of a single subject’s performance, to between-subjects’ performances.

Imagine a drug trial in which half the subjects receive our new anti-pimple pill (“Antipimpline”) and half get a placebo. We’ll compare pre-to-post improvement in those getting the drug to those not getting it. And we’ll look at a variety of demographic variables that might have something to do with whether a person responds to the drug: gender, age group, frequency of eating junk food, marital status, income, racial group.

Damn. Overall, our drug is no better than placebo. But remember that data are never smooth, like HTHTHTHTHT. They’re chunky, like HTTTHTHTTH. Trawl the data enough and we are sure to find something. And look! White males under 25 clearly do better on the drug than on placebo! The title of our research paper practically writes itself: Antipimpline reduces acne amongst young Caucasian males.

Okay, well even that causes some eye-rolling. Surely no one would be foolish enough to allow for a fishing expedition like this one. Or if they did, they would demand that you replicate the finding on a new sample to verify that it didn’t just come about as a result of the lumpiness of your data.

Well, wrong. Fishing expeditions like this appear throughout the literature.

The point, however, is that if we are looking for an effect, we will almost always find it in at least some of our subjects.

So What?

Let’s shift again – from comparing subject by subject data to study by study. We’ll do 20 studies of antipimpline, each on a hundred subjects. We’ll use the .05 level of statistical significance (meaning that we will get a random false positive about once in every 20 comparisons). Then we’ll define three primary outcomes (number of pimples, presence/absence of 5 or more severe lesions, and subject reports of skin pain) and two secondary outcomes (nurse ratings of improvement, reported self-consciousness about skin).

If these outcomes are not correlated with one another, we’ve just inflated the probability of getting at least one positive outcome to nearly 5 in 20 comparisons, or 25%. Nowhere will you see a study stating that the actual error rate is 25%, however. (In fact, the defined outcomes probably are correlated, so perhaps we’ve really only inflated our odds of success from 5% to 15% or so).

And what happens? Imagine we count as positive (we’ll denote that as ‘P’) any study that is superior to placebo on at least one outcome measure, and negative (‘N’) if no measure is significantly better than placebo. Here’s what we get from our 20 studies:

PNPNNNNNNNNNPNNPNNNN

From our 20 studies we get 4 showing antipimpline to be superior to placebo on at least one outcome measure. We publish those studies, plus one more (at the insistence of a particularly vociferous researcher). The others we dismiss as badly done, or uninteresting, or counter to an already established trend. Something must have gone wrong.

Publication is how studies become visible to science. So what’s visible? Five studies of antipimpline, of which 4 are positive:

PPPNP

Fully 80% of the published literature is supportive, so it seems likely we have a real acne therapy here. Antipimpline goes on to be a bestseller. What’s missing? This:

NNNNNNNNNNNNNNN

Lest we nonpharmacologists reactivate our smugness, swap out “mynewgreat therapy” for antipimpline and we can get the same outcome.

Way back in introductory stats class we could not believe that our instructor was giving us such a blatantly bad example of research. Obviously the deletion of trials not showing the “effect” meant that the work could no longer be considered science. It was firmly in the camp of pseudoscience.

Switch to reporting only some subjects’ data, and we have exactly the same thing: Pseudoscience.

And conduct multiple studies on the same question and publish only some of them? Once again: exactly the same problem. By deleting whole studies (and their statistical comparisons) we inflate the error rates in the published literature. And by how much? By an amount that cannot be calculated without access to the original studies – which you do not know about and cannot find.

As a result, without the publication of all studies on a similar question without systematic publication bias – it becomes impossible to know the error rate of the statistics. Without that error rate, the statistics lose their meaning.

* * * * *

References:

Goldacre, Ben (2012). Bad Pharma. New York: Faber & Faber.

Turner, EH, Matthews, AM, Linardatos, E, Tell, RA, & Rosenthal, R (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358,  252-260.

83 COMMENTS

  1. So basically, what you seem to be saying is that all pharmaceutical industry funded “evidence based medicine” has an unknown error rate of the statistics, because “the publication of all studies on a similar question” have not been published and are unavailable. Meaning all medical journals are filled with nothing but systematic publication biased misinformation, thus at this time basically all medical literature today is pseudoscience.

    Am I correct?

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    • I’m saying that there are flaws in the process that need to be addressed. There will always be flaws, but some of them are sufficiently well-known and obvious that it is bad practice to allow them to continue.

      Cochrane reviews and others do often manage to get reasonably complete data sets with pharmaceutical topics, so the problem is not completely intractable. As well, it is unlikely that so many trials have been conducted and gone unpublished (in most areas) that apparent positive findings are entirely due to chance.

      Many of healthcare’s most effective and helpful treatments have been found and validated based on existing research and reporting methods, but the knife is much more blunt than it should be, or needs to be. In the area of psychopharmacology there have been particular problems due to weak effects, short trials, an inattention to long-term outcomes, and significant reporting issues – to the point that confidence is often appropriately low in what the science actually says.

      So is medicine all nonsense and misinformation? No. When I look at the literature on alternative treatments the situation is generally much worse. But it could be much clearer than it is.

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      • Randy:

        Re: “When I look at the literature on alternative treatments the situation is generally much worse.”

        Here we go again…

        I would suggest that there are many forms of “alternative” medicine that have some pretty solid research backing:

        https://discoverandrecover.wordpress.com/research/

        Talk therapy.
        Toss out the drugs, and go with some “evidence-based” talk therapy.
        Always the same thing.
        Predictable on this site.

        Duane

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      • “When I look at the literature on alternative treatments the situation is generally much worse.”

        Randy, where have you been looking? Have you not read the plethora of testimonials on here and elsewhere? There are tons of stories now of people being harmed by conventional health care and people being healed by methods alternatives to what we have going on now in the mainstream, particularly in mental health care. Please think again before invalidating these. Falsely bashing alternatives with no foundation like this kills hope for people, which is the last thing we need. Thank you in advance for your consideration.

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      • Hi Randy,

        Thank you for your articles and for being so willing to engage with people who comment in such a non-defensive way.

        ‘ When I look at the literature on alternative treatments the situation is generally much worse.’

        Could you explain more what you mean by this sentence. It seems to be one of those very broad sweeping statement that should be backed up with more specific details.

        What worries me about your posts is that is seems to me [and perhaps I have grossly misinterpreted you] that you make ‘light’ of some of the extremely serious problems and damage that has resulted from mainstream psychiatry’s use [and in some cases force) of very powerful drugs even though those drug treatments do not a solid scientific base. The vulnerability of the people whose lives have in many cases been so negatively effected, needs to be taken much more seriously. INFORMED consent is a huge issue in psychiatry.

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        • Example: homeopathy. It does not work. Unless you have placebo in mind – for this it works very well and isn’t toxic. That’s why me and many other people, including doctors, are not necessarily against using it. Nonetheless it does nothing in terms of being a biologically active substance.

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        • One reason that it is so easy (and has become something of a cottage industry) to pick apart the problems in the science (or attempts at science) underlying many psychopharmacologic approaches is that the studies actually exist.

          There are problems with many of them, and with the way they are reported, or not, but at least someone is attempting to try out the treatment, see the effects on real patients and real problems, find the dangers, and figure out whether they work. Profit motive, ego, and optimism all serve as distorting lenses overlaid on this work, resulting in many problems and some treatments that seem worse than the placebos against which they are compared.

          My own field is psychotherapy, and I can say confidently that if the same level of scrutiny was applied to empirical investigations of therapy, most of the same problems would be seen (as I state in the article above). I don’t throw up my hands and retreat from the office, but I do recognize that much of the literature needs to be looked at carefully.

          Recently a chiropractor near me enthusiastically sent a photocopy of an article in a local newsletter suggesting that people entered an “alpha state” shortly after having a subluxation treatment. No control group, no actual outcome measures of real significance, no followup, etc. On the basis of this he was all set to start offering the service. I don’t know whether he has, but this is a familiar example of the level of analysis undertaken before people declare that they have found the “cure to all disease” or “a revolutionary new approach.”

          It’s possible to see this a few times and dismiss it, but after 3 decades of seeing the big new cure appear every few months one gets a bit jaded.

          There are some alternative or complementary approaches that likely have great value. Melatonin in the short term seems to be very good for jet lag (long term outcome studies have been disappointing). Trials of St John’s Wort for mild to moderate depression have been encouraging, though inconsistent. There are many other examples.

          But they need to be tested. It is not enough to come up with a great new idea that seems to make sense. We need to try it out in controlled settings and see if it really works, while controlling for expectancy and other variables. If not, we run the risk of asking people to spend a great deal on treatments that are worthless, or that delay the implementation of something that may be more effective.

          I’m not a fan of the degree to which pharmaceuticals are used to deal with psychological distress. I could get over some of that if a hard look at the data suggested that they were nevertheless effective over the long term and produced better quality of life. But at least there is some attempt to see whether they work. The reason many of us are skeptical is not despite the science, but because of it. This same scrutiny needs to be given to other approaches as well.

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          • Randy,

            My concern is that the medical evidence does now show proof that the antipsychotics do cause the symptoms of schizophrenia, but this is not yet being confessed by the psychiatric industry.

            Here’s proof from drugs.com that the antipsychotics / neuroleptics are indeed known to cause the schizophrenia symptoms:

            “neuroleptics … may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

            Once the actual medical evidence shows proof that a particular treatment causes the almost exact same symptoms as it pro ports to cure, shouldn’t this supposed treatment be brought into question?

            I hope this will happen.

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          • “But they need to be tested. It is not enough to come up with a great new idea that seems to make sense. We need to try it out in controlled settings and see if it really works, while controlling for expectancy and other variables.”

            Thanks Randy,
            I think I understand now that you were making the point that many alternative treatments do not yet even have a base of scientific studies from which someone could judge them as either effective or not.

            I think that is a very important point, and I imagine as certain alternative therapies (nutrition therapies comes to mind as one example) are taken more seriously, there will be more opportunities and funding to build a richer data base. When that happens, these studies would also need to be looked at so carefully before they could be used to ultimately measure the effectiveness of a therapy.

            However, if pharmaceudical treatment options have been studied and have not shown to be “effective over the long term or to produce a better quality of life” and that information is not shared openly with consumers, that doesn’t seem to be any `better’ solely because there was “some attempt to see if they work”. It would only be better if the information on whether the
            treatments work or not was passed on to consumers.

            As a consumer in western society where the medical model predominates, I already have the understanding that I ” run the risk of (spending)…a great deal on treatments that are worthless,” when I seek therapies outside of the medical system. What blind -sided me that was that treatments within the medical system also did not have a solid scientific basis and had such potential for harm.

            Your article is amazing in that it shows the flaws in the process of scientific study in such an interesting and accessible way. But to me the result of seeing those flaws, should be leading to a resounding call out for the requirement of informed consent for standard, accepted treatments.

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        • Sa – Agreed with calling spades spades: CBT is a camp within the system and does unofficially but generally contain folks who want to reign in those unscientific Hearing Voices people, and similarly its representatives are trying not to raise red flags on “non-patient advocacy models” for treatment beyond what it can get behind with the officially sanctioned British Psychological Report getting hawked here now by Lucy Johnstone &co. My criticism is less for what they and Beck put on offer than how they all promote it and defend it. There’s lots of history to the problems with getting these various pseudo-health authorities to stand back and encourage patients to take ultimate repsonsibility for their own choices. To admit the limited scientific validity of their claims, too.

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    • In essence yes.

      You can’t believe how frustrating it is when you’re actually working as a scientist. “Never trust the data which other people published” is a rule of thumb. That is of course not to say that every paper is fraudulent or that every lab is involved in these practices – there are clearly more prevalent when there are financial interests at stake – so especially in medical research. As a rule I’m extremely skeptical if not outright dismissive of anything that was published by people with a conflict of interests. The biggest problem is as author of this (excellent) piece describes: there’s simply no way to know how much of the data is wrong.

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  2. “Smug psychologists (and others) have stood by smirking, unaware that their perspective is elevated only because they are being hoisted by their own petards.”

    This made me smile from the familiarity of it. I hear and see this sentiment expressed quite a bit.

    So a few of the issues with which we are dealing, here, are 1) bad attitude, seemingly ‘narcissistic,’ from that description, and 2) lack of self-awareness 3) lack of insight, 4) taking themselves too seriously, and 5) being only self-serving.

    These are all issues of healing, personal growth, and expanding consciousness/raising awareness. Physician, heal thyself. Then, you can work with others with clarity and more effectively.

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    • Actually, I think they are issues of understanding good scientific technique, the problems of statistics and partial reporting, and the policies of peer-reviewed journals. We can be healed, grown, and conscious and still make all of these errors.

      By discussing some of the problems in existing science and reporting, it is not my intention to discard science and the need for careful attention to its principles. That puts us on the road back to armchair philosophizing, snake oil, and unmeasurable “energy fields.” Instead, we need a dispassionate examination of what actually works in therapy and pharmacology – and we will only get there with a more careful attention to science basics.

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      • Randy, I realized after reading my post again that perhaps it seemed as though I was directing it at you, personally, when I said that last part, starting with “Physician…” which was not at all my intention, so my apologies for seeming to address you this way on your blog. I should have put it in quotes, because I was making a general statement regarding a paradoxical imbalance in many clinical relationships. I do honestly believe that many clinicians are misplaced, due to their lack of self-awareness, but I was not meaning to imply this was you. I’d have no way of knowing this.

        Indeed, we can be awake and err, we’re all human, regardless of where we are on the evolutionary scale.

        Still, I’m afraid you’d consider me to sell snake oil and be ambiguous about energy fields, etc. That’s totally ok, I’m comfortable with how I practice the art of healing, despite naysayers and cynics. What I learned during my healing I’ve yet to see even remotely approached by the mental health field so far. In fact, what I and a lot of others found to be of intrinsic value is quite demeaned and stigmatized, but honestly, I got used to that particular tool of shaming invalidation, it’s rampant in the field.

        Anyway, multiple perspectives never hurt anyone, but so much of this we’ve already discarded and moved past, so I don’t see the need for more research and debate, many have found answers already–many of us to whom a dear ear is continuously turned, I’m used to that, too.

        I think academia needs to catch up with the real world at this point. That’s just my neutral observation, from my experience in both worlds–academic “healing,” based on academic research and profit, and authentic healing, which is based on ancient wisdom, personal experience, and faith in SOMETHING. I think that last part is a stretch in academia, which I think is significant in how striking the results compare between academic vs. authentic healing.

        So that’s my point of view, from my experience with all of this.

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      • Re: “unmeasurable energy fields”

        Toss out traditional Chinese medicine, acupuncture?

        Sure, let’s get rid of that new age (ancient) medicine and replace it with more talk therapy… After all, what could be based on more hard science than talk?

        Why the rant?

        Because I’m tired of professionals bashing forms of healing that work. Many of these professionals know nothing about these forms of “alternative” medicine… This leaves two options: conventional psychiatric treatment and therapy; neither of which have a monopoly on healing. The first, with a history of causing more harm than good for the vast majority; the latter, in the position to cause either , depending on several factors, not the least of which is the ego of the therapist, including his/her attitude about what healing means to the one being counseled…. their pre-conceived views on “alternative” therapies.

        Duane

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        • Duane, you wrote: “Talk therapy…Toss out the drugs, and go with some “evidence-based” talk therapy…Always the same thing. Predictable on this site.” In the original post and all of the comments to this point, the only mention of talk therapy is the authors’ claim, “Allegiance to a school of thought that promotes specific ideas (such as that cognitive behavior therapy is effective – one of my own pet beliefs) and a fear of opprobrium if one reports contrary data.” The only person here speaking of talk therapy is you.

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          • Academic,
            I believe one of the most important things MIA can do, is to provide solid evidence that a person can recover from “Severe Mental Illness” outside of drug treatment psychiatry.

            The link below provides a description of how the process of psychotherapeutic recovery works; and this therapists success in his work with “Severe Mental Illness” can also be substantiated.

            http://www.irishtimes.com/news/health/the-great-illusion-1.662763

            This Phd link below, gives examples of how people have recovered from “schizophrenia” and “bi polar” through group support (I did attend these groups myself and the author is telling the truth).

            http://programme.exordo.com/nursingmidwifery2013/delegates/presentation/100/

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          • Interesting link, Fiachra, and I agree with you about the importance of emphasizing recovering and healing from severe mental illness.

            That’s what I had originally came on here to talk about, one of the main points of the film I made and the presentations I’ve done, but then I discovered that for a lot of people, ‘mental illness’ doesn’t exist, so I had to sit with this and figure out how to integrate this reality into my awareness without invalidating my own story and perception. I think that’s mainly what I’ve been exploring since posting here. These multiple perspectives of what is or is not real has taken me on a bit of a journey, here. Been enlightening in so many ways.

            I love the title of the piece, and relate to it wholeheartedly–

            “Recovery from mental illness as a re-enchantment with life: a narrative study”

            Thanks for posting this, feels validating to me.

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          • There also would seem to be a close links between what works in psychology, and the philosophy of some of the traditional Eastern religions.

            Besides this, I think the idea that meditation can calm the mind and improve wellbeing, has been widely researched and proven to be true.

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          • I do agree there are fruitful correlations between psychology and certain specific spiritual paths that emphasize health and healing as a matter of integral well-being and peace of mind.

            My main issue with psychology centers around how it is integrated culturally here in the US, that’s all on which I can comment, since that is my familiarity. I learned a great deal as a psychology student and intern, but there is a pervasive cultural dynamic here which lends itself to insidious bullying, and from my experience it permeates this field. This is a highly narcissistic culture with over-the-top power issues, which makes these clinical relationships precarious. I had this experience repeatedly, which was extremely damaging to my psyche, and only served to repeat what I had experienced with my family. Textbook re-trauma. Fortunately, I got over it all with the other work I did to heal, and found good meaning to all of this.

            Perhaps it’s more on a culture-by-culture basis, than the field in general. After all, our psychology is not universal in nature, it varies from person to person, and it is so heavily influenced by culture, and sub-cultures within that.

            After all is said and done, I have no relationship with the mental health world here, because I do not relate to the cultural dynamics. Yet, I’m extremely familiar with them because I was part of this for so long, playing various roles. Makes for interesting contemplation for the purpose of deeper understanding of myself.

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          • Re the existence or not of ‘mental illness,’ I guess for me, it comes down to what I perceive as chronic sabotage–whether of self or others. I observe it rampantly. Whatever one calls it, it’s not safe.

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        • I have recently learned that acupuncture is not based on some mystical energy fields, but on lines of connective tissue beneath the surface of the body. These connective tissues are ignored completely in Western medicine, which puts all the emphasis on organs, but they are very important in Chinese medicine, which puts more emphasis on connections and relationships.

          Additionally, anyone who has been through and honestly evaluated an acupuncture session with a skilled practitioner can attest that it is most definitely scientific and mathematical in approach. We may not understand exactly why this or that point is associated with this or that organ or this or that extremity, but it is observable that they are connected and has been so observed for thousands of years. They can do SURGERY on an AWAKE SUBJECT using acupuncture – they obviously have a pretty damned good idea what they are doing!

          —- Steve

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          • Steve,

            Amazing, isn’t it?!

            Yet, there are conventional (western) medical proponents who continue to insist that acupuncture is pseudoscience. Follow the money (again)…

            I appreciate your comment on connective tissue, but it would be hard to argue that acupuncture doesn’t have ‘energy’ at its roots. Traditional Chinese medicine is involved in addressing imbalances – the flow of ‘qi’ (energy) through channels known as meridians.

            Western Medicine, not so much… unless you consider EKG’s, other measurements of the heart. If heart rhythms aren’t ‘energy’, what are they?

            We’re afraid of seeing things in ways that are not ‘conventional’… reluctant to think outside the box. Healing has to be ‘scientific’, or it isn’t real…

            Even when it works!… Or so many would argue.

            Duane

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          • Yes, energy fields are also measurable, if one really needs to see that kind of proof. These are measured in Hz. Dense energy is measured at something like 750 Hz and light energy is measured at around 350 Hz, something like this, don’t know the exact numbers, but this is definitely representative There is science behind this, but I don’t go there because I get this intuitively and it matches the teachings which I’ve run across and which resonate with me, personally. I practiced working with it, and it worked for me. Although the topic of measuring energy fields to determine density vs light is readily available on the internet.

            The significance of this is that whether energy is dense or light affects us in every way, especially emotionally. Negative emotions, cynical beliefs, and chronic resistance cause an energy field to become, literally, dense, which feel constricts our hearts in a way which we can feel when we’re attuned to our hearts. This breeds depression, conflict, rage, and violence. Our society is dense at this time, and the goal is to bring light so that shifts can happen with greater ease.

            Although in cynicism, there is a very powerful resistance to light, so the field remains dense, which is toxic and ultimately, dangerous, because it creates illusions due to lack of clarity. I would say this is exactly psychiatry and the mental health system, as well as other systems. But the mh system is among the densest I’ve seen, because its stated intention is to heal, whereas we all know it has caused way more harm than good, and there seems to be no reversal of this happening. That is extreme density, where it is so challenging to resolve issues, as there is really no light in that energy field, from what I can tell.

            Most often, we dissociate from density, rather than seeing it, feeling it, owning it, and working through it, which disconnects us from our feelings, so self-awareness matters greatly to determine whether our personal energy fields are dense or light. Density causes things to get stuck and risk spiraling downward, because it is harder for thought forms and bad feelings (all of this being pure energy) to process, as if it were trying to flow through very thick mud, which is dense.

            Whereas an open mind, optimistic thinking, thinking in terms of validating rather than denying, respecting boundaries and honoring our own, being mindful and respectful of others–all of this creates light energy fields, which makes it so much easier to process thoughts and feelings, moving swiftly through any issues we may encounter to create positive change and personal growth, because energy travels more easily and cleanly through light.

            That’s a matter of physics, and when we pay attention to how we feel in conjunction with the world around us, we perceive whether we are running dense or light energy, which is our personal contribution to the collective. If we wanted to measure this with an instrument, we could, and it has been done. But if we are connected to our feelings and self-aware, this is not at all necessary. We know by how we feel, and what we own about ourselves.

            In essence, we, ourselves, can measure energy by how we feel, it doesn’t have to be in numbers, we just go by how we feel, while understanding what is dense vs what is light, and we are free to choose which reality we prefer. If we want to shift the energy, we do this with focus. This is our power.

            I learned this way outside of anything mainstream in the US, but still, it’s all over the place, even in this country. I’m not in the slightest the first person to discover this, I was taught by wonderful teachers and healers, and I integrated it into what I had already learned in my life; although at this point, I am wondering if I’m the first from the psychiatric survivor world, because I get more arguments here than not, from those who have never studied and applied the principles of energy. That would be a requirement before taking this on, because it’s all experiential, that’s how we learn this, by practicing it in everyday life, with this focus on: how does the energy feel (inside and out)? I’m definitely not the first to ask this question about myself, or upon entering a room, and it’s a really great first question to ask oneself.

            I taught this to my partner, and it works for him, too. My clients also learn about energy, and their lives and health have at the very least improved markedly, without a doubt, and in some cases, they have transformed into a new perspective, which is life-changing in the best way possible.

            I found this area of study to be absolutely VITAL to my healing, which is why I teach it. It’s a different focus than that which fuels academic research. For me, it’s been totally reliable, whereas studies and science regarding mental health and related issues was completely irrelevant. All that mattered to me was how something was affecting me, not what others would say about any of this. It’s my unique process, so I wouldn’t expect too much of it to match up to others, although I do feel there are a few universal principles here, but that is for another discussion at another time.

            I understand very well that others go by what researchers say. I really and truly prefer to trust my heart, intuition, and inner guidance, especially when it comes to my own health and well-being. It has not failed me yet.

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          • It reminds me of my friend who is practicing yoga and meditation who noticed that certain chakras seem to be placed curiously close to major nerves and plexus. There is more to old day medicine than we realize.

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          • Yep, you’re getting it, B. Keep going. As I learned this, I was able to make all of those correlations, too. It’s all connected. Kabbalah tree of life is interesting to look at, as it tells the story of our being-ness. It all relates to what we do know, but it is a broader and less personalized perspective. That’s our job, to apply it, but these principles are universal. When we discover this, we are considered to be ‘awakening.’

            Carolyn Myss’ Anatomy of the Spirit (1996) connects several spiritual paths with ancient healing wisdom and modern medicine. This is what began to shift my perspective, it all made logical sense. She’s a medical intuit, which is who I saw to ask how to get off all of this medication I was on. The medical intuit gave me the recipe for what would be appropriate to me, I followed it diligently, and it worked. Not 1-2-3, it was hard work of course, but I hung in there and completed that journey.

            Then, I studied with her and did an internship, to become a medical intuit. I’ve now integrated this into my practice, and enjoy teaching it a great deal. I find it extremely efficient and practical, most clear information I ever got regarding healing.

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          • Hey, Duane,

            Real science is about the outcome, not the theory. A hypothesis is only as good as it is useful in predicting outcomes. We can spend all the time in the world arguing about whether “ADHD” or any of these dumbass labels is a “disease” or not, but the bottom line is, their theory has zero predictive value in altering outcomes.

            Even if you don’t know the mechanism, it’s hard to argue with a 5000-year-old practice that allows complete anesthesia in a waking human. That’s what I call a result! The fact that modern researchers can’t or don’t want to find an explanation is their problem. The results speak for themselves. As to the results of psychiatric “science,” but their message is quite a bit different…

            — Steve

            —- Steve

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          • Steve,

            I can appreciate what you’re saying, at least on one level – the level of science.

            But when we’re talking about human thought, emotion, behavior, we move out of the realm of “hard” science, into the level of healing – body, mind, spirit – connections, at many levels.

            I agree, when we’re talking about altering brain chemistry, with some of the most most powerful and dangerous drugs on earth, show me (and everyone else) the science!

            … Unfortunately, there is no science. The clinical trials have been manipulated; data tossed, there’s nothing there. The FDA has failed, so have the state medical boards – there’s been no oversight.

            The other factor – what are people to do? Wait until more studies have been conducted before trying vitamin B-12 and D-3 for depression? Wait until more data is available before trying neurofeedback for anxiety; or trying hyperbaric oxygen therapy for post-traumatic stress? What if it’s a long wait? Wait anyway, until enough psychiatrists agree that the research is above board… or enough psychotherapists?

            Talk therapies, like CBT are supposedly “evidenced-based,”
            but I would argue that are *many* other well-documented therapies as well, that do not involve talk.

            At the end of the day, when we are talking about thought, emotion, behavior – and all the variables involved in those areas, how much pure science is left? How much was there to begin with? !

            X amt of subjects in study one showed significant improvement in mood? That’s science? Define significant improvement, define mood…. hell, define study! What measurements, what controls are used?

            Human clinical trials have tons of uncontrolled variables. A study on depression might involve a complex group: a person who lost their job last week; another whose aunt was just diagnosed with cancer; someone else was married two weeks ago; another is in the midst of a custody battle with her husband…. And the objective is to conduct a study on the benefits of a particular therapy for depression. We’re not exactly in the chemistry or biology lab anymore!

            It’s subjective.
            To say the least.

            Which is why, IMO, people who want to study science and conduct scientific research flock to *hard* sciences: chemistry, biology, physics, astronomy.

            Most graduate programs in social work, psychology, counseling may offer coursework in statistics and the scientific process. But the study of human behavior is *not* the study of chemistry, biology, physics. In fact, a professor I had in sociology probably said it best: “Human behavior is unpredictable.” I agree (some 40 years since taking the course).

            I say:

            Let science (real, hard science) be science.
            Let healing of body, mind, spirit be much *more*!

            Duane

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          • Steve,

            As one who had minor surgery last week, that would have been very interesting to experience acupuncture instead of anesthesia. Fortunately, thanks to my concerns about med sensitivities being taken very seriously, I came through it very well with the exception of experiencing PONV (in spite of a prophylactic medicine) which I will settle for any day in light of all the risks.

            I am curious, are there any hospitals in the US who use acupuncture for anesthesia? If there were, that would be a great option for people who fear surgery but desperately need it to improve their health.

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        • Hi Duane, I appreciate that you kept me directed for following the drift of the thread, relevantly. Something good just happened to me that coincidentally has to do with my connection to any interest in CBT”s effectiveness, but why go into it. It was just good and the CBT book didn’t tell me how to work toward it or conceive of its description according to the most current leading theory…. The thing that mattered was sending an email to one former therapist.

          Anyway, Duane, I hadn’t read the whole of your long post. Your position matters to me relative to its mattering to you, which is my whole rule for that, and I see so little to question you about. I rolled over one day and woke up in the generative phase, and that keeps me most occupied with how people think it’s alright to kid themselves or dream on–you?

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          • I’ve probably already made my fair share of comments on this thread, and hesitate to leave many more….

            However, you asked “you?”
            I do not understand your question. I will simply respond that I think CBT can be an effective way for some to heal. One of many ways.

            Duane

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      • i.e. Don’t fault the process, fault the processors. True; yet it is part of the process that has no checks and balances that allows for bias and misuse of information. The integrity of the field is relinquished when these facts of systemic failure to comply with ethical efficacy are brought to light, in turn it discredits all involved directly and indirectly by its revelation, so through fear and failure aversion (professional/personal regardless) the broken model is perpetuated and allowed to breath freely, insidiously perpetrating fallaciously as scientific evidence.

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  3. Dear Randy,

    I consider myself a scientist so I like your scientific presentation but I am amazed that anyone would consider it scientific to hide information.

    Support for the medical model is pure pseudoscience; the real science of psychology and mental distress is at NaturalPsychology.org. I would appreciate your scientific criticism.

    Best wishes, Steve

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  4. I know nothing about statistics, but I’ve Always said you can hide anything with it.

    When I first took notice of how my own medicine had been frauded through the system of safeguards, I was chocked. Because as an “average Citizen” I only assumed that the trial periods of my medication was almost fail safe. And that the next step, individual user adverse event report system, made the overall knowledge more and more extensive.

    But right now, none of the systems are working. Randomized Controlled Trials (RCT’s) are, as you say, tampered with. (Hiding of data, false positive interpretation of data, lack of full disclosure of data for peer-review, selection of data to publish and so on..)
    Adverse event reporting systems are on most cases run by, or governed by former Big Pharma employees. An overwhelming acceptance that reports are “anecdotal”, no matter how re-accuring or how statisticly significant they are, they are “still anecdotal”.
    Sweden has an even worse example of adverse event reporting system: “the national board of Health” has shifted the responsibility of administer adverse event reports back to the Pharmaceutical companies themselves!!! (Where they ofcourse gets lost in some file cabinet and regarded as a Company secret, because in Sweden it’s almost impossible for a patient to sue the Company.)

    So, once again as you say, where scientists have but a few simple rules to follow to produce good science. They fail at the very basic requirements.

    Nothing but full disclosure of raw data, every attempted research must be filed and accessable.
    Scientists must be able to withstand scrutiny and even face possible prosecution if recurring malicious
    behaviur is detected. Any scientist (or other human for that matter) are perfectly allowed to have a personal opinion, and so speak it, BUT, their science MUST be unbiased in shape and form. Any Company sponsored research should be considered as “anecdotal” until sufficient number of unbiased reports have concluded the findings. (…”oh but no Money exists if it weren’t for the companies paying the bill”….So be it, we want unbiased science or no science at all, when it comes to medicines we are supposed to be able to give our own mother!)

    Sorry, got a Little carried away there, but what a nice original post by mr. Randy Paterson

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    • 1. All trials have to be pre-registered and approved by ethics committee as well as design of these trials has to be proved valid

      2. All patients have to be followed and clear reasons have to be given for drop-outs

      3. All data (excluding patient personal information which allows easy identification) should be openly accessible for anyone at the end of the trial

      4. All trials have to be published

      5. Trials should not be conducted by people and entities which stand to profit from either result

      Does any of it sound unreasonable?

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      • I would add that ALL trials must be submitted to the FDA or other approving agency for consideration, and approval should reflect an analysis of ALL data submitted, rather than the “best two” approach that is currently used.

        Of course, your other requirements are more than reasonable.

        Oh, and no “placebo washouts” are allowed, either. Placebo effects are legitimate effects, and removing them biases the research in favor of a positive finding.

        — Steve

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        • Steve – Re: your last comment to Duane above …”their theory has zero predictive value” –right.

          I appreciate your stamina in keeping up with the thread and helping everyone to clarify hunches and insights. You’re almost always right. Here you bring the general response back to about the most meaningful explicit connection to the intrinsic value of the article. But all the CBT books refer to labels and hold forth with their guidance counselling in terms of no real additional harm done by the most common bad treatment protocols. Until you get started on the good CBT thing, you just must have some stable symptomatology that waits around in the shape of the true disorder. “Right, doctor?” So…– Good. But yuck.

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          • Please read my response to Steve on the thread.

            Science?

            To be successful, psychotherapy requires finding a therapist with a “personality” that is a good match for the client (along with values, etc), in order to form a “therapeutic relationship”.

            Subjective, don’t you think?
            Hard science it is not.

            Duane

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          • Thanks for your kind comments, Travailler-vous! I do agree with Duane that good therapy is not and never really will be science. It’s about being human together with another human. What works is what works for you, and it might not work for someone else. My biggest beef with the psych industry (and I have many) is the denial of the right of the recipient of the “help” to decide what is and is not helpful for them. A good therapist (admittedly not the norm or average) is one who can adapt what s/he is doing to help the client from the client’s own viewpoint, and will be creative in finding an approach that will get that job done. The idea that some “manualized” approach will work for everyone with a particular set of “symptoms” is nonsense.

            CBT is just a way of thinking about making changes. As Duane says, one of many. Everyone’s path is different. All a good therapist can do is help the person find their path, and encourage them to walk it.

            — Steve

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          • Steve – Your welcome for them as ever. I can’t pretend to argue with your idea of how to get your gigs or keep them right. The problems with psychology proper are all matters of pedigree to me. The only point of that is to understand the increase to pure knowledge made by particular fruitful approaches, and so. It’s little walk of fame version, however, is undesirable for helping it to achieve the version of its stated aims that you stand for. Returning the diagnostic categories on MMPP-II, great heroes who never said no to lobotomy or (in-)civil commitment are so uninspiring, also. Take care and for what it’s worth, I will more likely catch up to your work in the thread after Bonnie’s book release event than before.

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        • Therapy can be no more scientific than our understanding of our own nature. Just as dating websites and employer search engines work to fit within the grasp of our current best understanding one person to another or to an entity such as a corporation or company, we are able to match people to people with compatibility algorithms. Therapy is such currently that it does not acknowledge this ability because of the many other various factors hindering or supporting those seeking services. The stigma of the client is as much affected as is the stigma of the provider. when the coexistence of both are less stigmatized the process of matching one to the other will inevitably smooth out.

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  5. A nicely written, and sober appraisal of where we are in analyzing outcome data regarding the treatment of mental disorders.

    As someone who is a neuroscientist, psychotherapist and psychopharmacologist (and I suppose somewhat obsessive in trying to figure out things), it is clear that all we have now is different ideological camps trying to support their “skin in the game”.All the while downplaying the significant risks of the interventions they use (psychotherapy perhaps having the greater long term risk, and pharmacology the great short term-though it may be a toss up).

    As the great medical scientist Claude Bernard noted in the early 1800’s, that until we have models of disease states, we have very little.Without models,the arguments will go on for the next 100 years as they have gone on for the past.

    Thanks for the well written piece.

    MP

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    • like the person posting below I would like some evidence of what you say. Scientific studies or personal experience would be of interest.

      I have been helped by therapy and also harmed by therapy and I took part in a study on harm in therapy. However I think there are very few such studies.

      As to the comparison between long and short terms harms of therapy and drugs I have heard nothing.

      What I am interested in is the comparison between no treatment, drug based care and therapy for psychiatric conditions. It may well be that no treatment is best. Until we have evidence we do not know for sure.

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        • John,
          So, more straightforwardly, what technique cannot be implemented badly? I would doubt a CBT artist’s claim that no good use of a biofeedback machine that helped you lower alpha states and increase theta states can be proven yet. I think there obviously are myriad uses for such a procedure and the only thing stopping the spread of it is bad therapists, lack of imagination for studies, and shoddy notions of how to administer lots of access to the equipment.

          Our CBT coalition is Peter K., Lucy Johnstone, Ann ?–I trust and like them, and the folks who sow seeds of doubt about their integrity strike me as truly chauvinistic in their aims. Even so, CBT is as scientist-ic as it is scientif-ic. You can’t develop an ontology to support its claims, if my source for that is right. And you can think it over yourself. What actual t-h-i-n-g-s are the measuring ever?–Interpretations, period. It helps to give a second to thought in the name of managing your emotions, but what if you are already good at it? Now you develop this tendency to fill out little forms to see what everything might have been about if it hadn’t been caught in the act and “revised”. The symptoms lists that most of its handbooks addresses work as prompts for how to conceptualize something you are feeling and put it into pre-set categories, but with PTSD, for example, it might need ten other sets of lists equally well. It’s a big forced re-education effort in that regard. And as Sa says above, Are they criticizing what damage orthodox treatment is doing already? Not enough–

          It’s good for ideas and to give the clinician distractions from telling you how to behave, but it’s still relating that gives you space for trying yourself out in different moods and different situation ensembles of stressors and rewards. Yet Peter, Ann, and Lucy J. are up to something good. Just not gospel truth money back guarantee good with anybody who ends up doing it. When you can devise an infinite number of psychologies, and you can, why pretend that only one is right?

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          • Just came across this…. I’m glad you like and trust us, travailler-vous, but I’m not sure how you concluded that I (I won’t speak for Anne and Peter) am part of some ‘CBT coalition.’ CBT is mentioned only very briefly in the BPS report, along with a whole range of other therapies and interventions. The report was a group effort and does not exactly represent any particular individual’s views. In fact I rarely use CBT. I am more interested in trauma-focused approaches.

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    • To the contrary, I think the evidence in the psychiatric field is that drugs can be useful in acute care, but are increasingly dangerous the longer you use them. I’d be interested in your comments regarding long-term damage due to therapy. If you’re talking psychoanalysis, I might agree, but I think it likely that quality therapy can have a very positive long-term outcome profile, even though it is likely to take a lot longer to take effect than the drugs.

      —- Steve

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        • Duane – I was just looking to keep up with you and follow your point. The sequence doesn’t work so will because your posts all end up after a time delay. But yeah, that’s enough. The question was just along with my remark about being old…in the generative phase. Do you stay occupied with everyone’s welfare and their ability to address it? was the point intended. Your notion of CBT’s worth is amply generous. It’s not got final steps to growth and recovery right.

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        • Duane – No button for your last reply to me. To clarify myself, I had thought you had acquaintance with or background in the social sciences somehow since first seeing your comments. I worked in private enterprises, formally studied as little social science in the guise of instruction for working the field as was possible for me in light of fulfilling academic requirements. And I meant about people and their illusions, not so much how they get or don’t get well or “abilified” or about whether the inner child or the cognitive errors need their attention. I was still talking in reference to the context of crime and cover-up that Randy thinks we aren’t talking about in regard to his occupation and his peers.

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    • T. M. – Alex posting above has a point relevant to yours. Randy fielded it with somewhat narrow intent, but taken more broadly her idea can just be thought of as looking for ways of seeing who has what it takes to interact effectively in human relations fields, and currently no determined effort to keep that topic in ongoing debates (that the public might see) happens.

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    • TsMonk,
      It would be good to see some evidence for the notion that psychotherapy has the greatest long-term risk. Until that is provided, this statement seems to me to be speculation or anecdotal opinion. I don’t mean this offensively, but perhaps you have seen a large number of difficult psychotherapy cases yourself or you have had a disproportionate number of cases take a wrong turn in the long term. That could (or could not) happen for any number of reasons. But if so, that alone wouldn’t be generalizable evidence about psychotherapy.

      I’ve found some good long-term evidence about benefits of psychotherapy; you may remember I posted the 3 long-term studies in Whitaker’s earlier article. Essentially, the bigger picture seems to be that while psychotherapy can cause harm, in the long term, the rich get richer (i.e. more often than not those who get psychotherapy benefit on various measures).

      If anyone wants I can repost these links.

      I also find it curious that psychotherapy is so often compared to medication. In many ways, human relationships are much more varied and complex than pills. Each psychotherapy is unique and constantly evolving and varying from beginning to end. But each Zyprexa pill is not unique and does not evolve or vary from beginning to end. Well, maybe it does, if the factory messes up and keeps putting in new ingredients. So when it’s made this comparison to me is a bit spurious.

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  6. …”psychotherapy perhaps having the greater long term risk, and pharmacology the great short term-though it may be a toss up…” Really? As a “neuroscientist, psychotherapist and psychopharmacologist,” surely you can inform us about the scientific research that supports this claim. I eagerly await your response.

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  7. A great article on the research in a field that desperately needs some kind of scrutiny and oversight. I was thinking myself about ways in which the title might be rephrased. For instance, Does Published Data Make Pseudo Science, especially since so much of it remains unpublished. Yep, that’s right, unpublished, ignored, and suppressed data can’t make your science very sound, not if you’re claiming to be a scientific. I don’t think it would be an understatement, when considering the commercial interests who are behind this kind of suppression and twisting of the “evidence”, to say that there is a real coverup taking place in the field of psychiatric research. Thank you, Randy Paterson, for going there.

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    • Thank you for this – I had not read this review. It echoes (and backs up with actual data) much of what Ben Goldacre talks about. The Editor’s comments focus on how pre-registration of trials and mandatory publication are likely to help the situation. There are two problems with this:

      1. The obligation to publish does not necessarily deal with the non reporting of nonsignificant primary outcomes, nor the problem identified by these authors of certain outcomes mysteriously going from nonsignificant to significant in the writing process.

      2. Goldacre reports that the stated commitments of journals to publish only pre-registered trials has been largely ignored, with journals routinely publishing non registered trials just as they did before.

      This is a valuable paper and I would refer interested readers to it.

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      • I think requirement to publish raw data could also prevent a lot of misconduct. It’s easy to colour up your results in a paper but fake all the entries and datapoints is quite a different pair of shoes. Also the removal of study subjects without recording reasons why their left and data obtained prior to them leaving is crucial (even if there is no misconduct it introduces a bias where non-responders and people with severe side effects do not show in the final picture).

        It should all be common sense… Maybe I’m wearing a tinfoil hat but it feels to me like this system may be broken for a reason.

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    • Mark – On your link, the line of criticism that R. goes into here is generally the case throughout science presently, just worse with human sciences. To get a really clear understanding of the sorts of issues with keeping psychology honest and productive, and to see how it cannot function as a be all and end all road to self-sufficiency, inner peace, and great insights, please check this out, too.

      http://www.cato.org/sites/cato.org/files/pubs/pdf/pa590.pdf

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    • Randy – Thanks, indeed for taking the risk of getting didactic. All the best MIA compatriots are here, and my comments above are offered in spirit skeptically for reasons that I stand by, but that are only said as well as I could, nevertheless. We used to have a radical psychiatrist blogging here named McLaren, I believe, and that was my introduction to Turner’s article on bias. One way of telling you what lacks in the CBT approach is this: the talk of the goal is feeling and knowing how to express all your emotions. The list then runs: anger, surprise, fear, joy, etc. But what about rage and despair? As you should admit, they are swiftly medicated. But there’s no hurry, it’s only been thirty years waiting to meet someone who heard about real trauma and asked if it ever made me feel cut-off from real life.

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  8. Duane – So my take on Steve M. is that he is mostly right, and when wrong usually it’s for wanting to keep things light. Light as in “accessible” to the person who hasn’t got the point yet about something.

    Take the fact of what things can’t exist, for instance. He bums about that now and then.

    But the things that all fit together once you begin to understand according to clear ideas are so-o-o satisfying. I always feel sure that intellectual bite will be the reward of a lifetime, myself.

    Therapy doesn’t exist, for instance. Smart little muckraker Amy Watt. Szasz wrote the book on that just fine, too. So he couldn’t sell his convictions to the dog and pony show of Psychiatry and CBT, is that why to pretend things should exist just a little while to stifle someone’s sobs about it? I guess so.

    Anyway, the relationship fundament stands in proper relief against the correct conception of therapy as the abstraction after the fact if you, the client, adjust. All you have to double check in sessions is whether you fully understand that it’s totally you adjusting, as in the intransitive case. No one’s adjusting you. But good luck finding therapists who won’t try that fun impossible thing indefinitely. That’s one of the things CBT does, keeps the therapist tasking with his little quiz. But you, the client, once in there are adjusting in solo, and you got therapy because you had a chance to, not for walking some line.

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  9. Fiachra – Your links to Academic, FYI. Intense. The Irish Times article. We have nothing so sanguine and pro-choice here in the regular daily rags.

    We certainly need customer data flowing out of the services on offer like we get here…and the encouragement to be gained be off the beaten path recovery stories. I see the missing element to be theoretic justification for both the therapies in place and similarly understand the primary need of survivors to make unrelenting criticism for the lack of acknowledgement of what in the case by case rundown of present bad treatment (and never making up for it) dare not speak its name.

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