How Dissenting Voices are Silenced in Medicine

Researcher criticizes the many ways opposing viewpoints and dissenting voices are squashed in the field of medicine.


In a new editorial in the journal Psychotherapy and Psychosomatics, psychiatrist Giovanni Fava of the State University of New York at Buffalo writes a scathing critique of the demise of pluralism and dissent in medicine.

Fava lists several ways that dissent is crushed in medical research and practice, especially through industry influence, bias in publishing, and over-dependence on randomized controlled trials. He remarks that there are several commonplace industry practices, undertaken by researchers and clinicians, that support the status quo, squash disagreement, and reward mediocrity.

“True talent is threatening because it is frequently associated with independent thinking, which undermines the power structure, while mediocrity assures lifetime commitment. Fighting the cult of mediocrity is the ultimate pathway to fostering pluralism in clinical research,” he writes.

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The traditional narrative about the history of medicine and psychiatry is rooted in ideas of progress. Many have claimed that there is better awareness of ‘mental illness,’ reduced stigma, and better medicines to treat them. Despite these claims, numerous studies have come forth challenging these stories of linear progress. Some have undermined the field’s claim to objectivity by showing that diagnosis and treatment are subject to racial and class-based bias, while others revealed that the bio-medical model’s contention that “mental illness is like any other” can increase social distance and perception of dangerousness about the individual.

The most consistent criticism of the discipline has come from service users and psychiatric survivors who have long questioned the use of  antipsychotic drugs long term, arguing that it inhibits recovery and functioning. These groups have also fought against the deliberate silencing of their voices in the psychiatric debate and called for the inclusion of client input in the formulation of psychiatric diagnosis and treatment.

Despite these criticisms, dissent has not always been welcome and, in this editorial, Fava points to the numerous ways it is quieted in the field of medicine, resulting in intellectual stagnation, and more dangerously, the dissemination of propaganda.

He first exposes the various ways academic publishing hides disagreement and the plurality of viewpoints on any given issue. Since the financial burden of open access publishing falls on the author(s), it ensures that research funded by grants, industry, or other big institutions gets published. This creates a situation where researchers with conflicts of interest are more likely to get published. At the same time, independent researchers with innovative findings, especially those who duly report the side effects of drugs, are unlikely to be published or funded.

The commercialization of academic journals has led to a reduction in correspondence sections that host different viewpoints and debates. Additionally, there is a trend to include a number of renowned authors, not because they have contributed to an article but because they provide consensus. This inflates the author’s ‘h index,’ which measures their citations and productivity. In effect, many studies, especially psychiatric drug trials, are essentially ghostwritten.

Other studies have similarly pointed to bias in publishing. For example, psychology and psychiatry research abstracts are manipulated to imply significance when none exists. This has dangerous implications for clinical practice as it was found that clinicians often base their decisions on what they read in the abstracts.

Fava goes on to show how powerful special interest groups, often backed by corporate interests, block the distribution of information they find unappealing. They censor this information by sometimes intervening as editors or reviewers, picking and choosing literature that benefits them, and by spinning results of clinical trials. Sometimes the investigator him/herself/themselves censors their results because they fear ostracism by the academic community. Others have similarly shared experiences where reviewers often reject articles based on what threatens their personal orientations.

Fava further asserts that overdependence on randomized control trials (RCTs), and more recently meta-analyses, is another way pluralism is discouraged. RCTs often only show the efficacy of a treatment for the average patient without considering the individual clinical presentations of different patients. This is in line with a new review which found that “empirically supported treatments” (also known as evidence-based therapies) might not be built on sound evidence after all.

Even systematic reviews are prone to issues as many have no authors with clinical experience and thus little grounding in actual practice. Fava considers this disconnect between researchers and clinical practitioners as the central cause of the intellectual crisis in medicine. He uses the example of the expulsion of Peter Goetzche from Cochrane to show how evidence-based medicine often erroneously forces the idea that there is only one treatment available and punishes any dissenting voices.

He further writes that meta-analyses can often homogenize the results of studies that were conducted based on vastly different criteria and protocols, and in effect can be useless when it comes to individual patient care. Thus, although meta-analyses are considered the “platinum standard” of research, they often produce conflicting results and are equally vulnerable to researcher bias.

Fava further suggests that meta-analyses can also overestimate benefits without paying serious acknowledgment to side effects, and this is often guided by commercial interests. Citing psychiatry as a field replete with such problems, he gives the example of a study that found industry influence, and thus conflicts of interests, in two-thirds of the meta-analyses on antidepressant drugs. Other studies have similarly problematized widespread industry influence in the healthcare sector. Findings suggest that the pharmaceutical industry is trying to use the euphemistic phrase “discontinuation syndrome” instead of “withdrawal” to smooth over the adverse effects of anti-depressants. Fava writes:

“Iatrogenic manifestations of behavioral toxicity, such as withdrawal syndrome and persistent post-withdrawal disorders, have been censored and denied funding and attention.”

In the end, Fava offers some ways that pluralism of viewpoints can be introduced and dissent against hegemonic practices appreciated in the field of medicine. He suggests that medical journals must welcome debate and dissent and base their publication criteria on sound methodologies and not popular theories. The content of a journal should be autonomous from its financial source.

Further, over-dependence on evidence-based medicine must be restricted and these trials should be integrated with clinical practice and knowledge. Instead of conducting bigger trials with wide inclusion criteria, it might benefit patients more if smaller trials with more specific clinical criteria were conducted by, for example, working with sub-types of depression or according to the medication history of a patient. Often researchers overlook the fact that current symptom presentation could be a result of patients’ past treatments which had severe adverse effects (called iatrogenic co-morbidity).

A recent positive development in the field is medicine-based evidence (MBE) which evaluates efficacy based on biological and biographical criteria. Fava writes:

“It builds on the archive of patient profiles using data sources, including both clinical and socio-behavioral information. The clinical seeking guidance for the management of the individual patient will start with the patient’s longitudinal profile and find matches in the archive, which provides an important source of therapeutic pluralism.”

Additionally, public funding sources should prioritize innovative research and academic promotions should value independent thinking and original contributions over the quantity of articles produced. Given the rampant industry influence in not only research but also education, it is all the more essential to give voice to disparate and disagreeing sources. Until now, only a few in the discipline of psychiatry have responded positively to any form of dissent.



Fava, G.A. (2019). The decline of pluralism in medicine: Dissent is welcome. Psychotherapy and Psychosomatics, 89, 1-5. (Link)


  1. “reward mediocrity.
    “True talent is threatening because it is frequently associated with independent thinking, which undermines the power structure, while mediocrity assures lifetime commitment. Fighting the cult of mediocrity is the ultimate pathway to fostering pluralism in clinical research,” he writes.”

    Thanks Ajurdi.
    Mr Fava, stating the above, which really sums it all up.
    And so Mr Fava has a good idea of how interactions with psychiatry is really like for those seeking it as a form of ‘help’.
    If psychiatry is difficult for those inside it’s circles, imagine how it is for the true underdog, the client.
    So do something.
    Gather the wheat from the chaff and work with clients to design something that is indeed not stigma, that develops a system where no labels are given.
    The WHOLE reason it is NOT working IS BECAUSE, it was based on the DISCRIMINATION and BIAS and JUDGEMENTAL queers we happen to be naturally. And we cannot have any system based on craziness. We cannot trust ourselves to be able to identify sanity, and normal existence.

    So do something more rational, more in line with ALL OF OUR CRAZYNESS.

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    • I contend that so-called “mental illness” is something that either ALL of US have it, or else NONE of US have it…. It MUST BE one or the other! I suppose it could be *both*, but it can NOT be neither!….
      So either we are all crazy, or else none of us is crazy. And neither of those options says anything good, at all, about the pseudoscience known as “psychiatry”….btw, so-called “mental illnesses” are exactly as “real” as presents from Santa Claus, but not more real….

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  2. Forgot to mention the ‘hot shots’ being dished out in Emergency Depts for dissenters. That tends to shut them up and ensure that any one else who is considering criticising ‘Doc’ from speaking up.

    Load em up with benzos and tip them over the edge with some other patients morphine I say. Then watch as the Coroner writes “death from morphine from an unknown source” on the paperwork.

    Boans sings, “They smile to your face, but all the time they want to take your place, Backstabbers” 🙂

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  3. Hi Ayurdhi, this is a good subject.

    You’ve got the medical top dogs in charge, connected up with pharmaceutical, political, and financial interests – and the ‘professionals’ underneath are the serfs. And if they rock the boat they won’t eat.

    The top dogs decide what the illnesses are, and what the cures are. And the politicians controlling the public funding – fall in line as well.

    The corruption has been around a long time, it’s obvious, it’s visible – and it’s Blatant.

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  4. Peter Goetzche has supported the idea that Psychiatric drugs do more harm than good, and (I believe) that even ‘Schizophrenics’ can Recover without consuming them, with support from (even) non professionals:-

    But this is exactly true, and has been reliably recorded many times on Mad In America.

    Probably the only Genuine Recovery from ‘Schizophrenia’ has been through rejection of the Psychiatric Drugging Approach and there is plenty of solid evidence to back this up.

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    • I believe, Fiachra, that psychiatry can NOT truly be “recovered” from, because they say it’s a permanent, incurable “mental illness”…. Just because Santa Claus doesn’t bring you presents anymore, doesn’t mean that other children don’t still get them….

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  5. Fava is correct, “‘True talent is threatening because it is frequently associated with independent thinking, which undermines the power structure, while mediocrity assures lifetime commitment. Fighting the cult of mediocrity is the ultimate pathway to fostering pluralism in clinical research,’ he writes.”

    Absolutely, psychiatry/psychology and their many “mental health” and school social worker minion, want to get their hands on anyone outside the norm, especially the best and brightest. It was when my well behaved child got 100% on his state standardized tests, that a school social worker called me, spewed insanity at me, in the hopes of getting her grubby little hands on my child.

    Truly, the “mental health” workers – who want to murder/steal from/control the best and brightest people in our country – are working within completely corrupt industries. But, of course, they had unwisely been given absolute power, thus, of course, corrupted themselves absolutely. That absolute power must be taken away, America was founded upon the principle of separation of power.

    Not to mention, the “mental health” workers are completely lacking in ethics. A psychologist recently deceptively attempted to steal all profits from my work, my work, my family’s money, and take control of my story, accountants, and lawyers, because my artwork is “too truthful.” The “mental health” workers truly are just a bunch of criminals. And if the “mental health” workers don’t want the artists to paint their crimes, the “mental health” workers should learn to not attack the artists. Apparently they forgot that “a picture paints a thousand words,” thus the artists have a powerful communication tool?

    And the “current power structure” does need to be undermined. For goodness sakes, “We now live in a nation where doctors destroy health, lawyers destroy justice, universities destroy knowledge, governments destroy freedom, the press destroys information, religion destroys morals, and our banks destroy the economy.” Upside and backwards, America. We need major systemic changes.

    And the “mental health” industry – that is killing 8 million innocent people a year, every year – does need to start to listen to, and hear, and mentally comprehend, the intelligent people speaking the truth about their modern day, ongoing, psychiatric holocaust. And they need to garner insight into the total scientific fraud of their entire DSM theology.

    And they need to garner insight into the common adverse and withdrawal effects of the drugs they are forcing onto innocent others. Like, for example, the antidepressants and ADHD drugs can create the “bipolar” symptoms. And the “schizophrenia” drugs can create both the negative and positive symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome and anticholinergic toxidrome. The seemingly intentionally ignorant “mental health” workers are committing iatrogenic harm on a massive societal scale.

    We are now living “In a Time of Universal Deceit,” where merely “Telling [or painting] the Truth Is a Revolutionary Act.” But since the primary actual societal function of both the psychiatrists and psychologists is covering up child abuse and rape, which is illegal.

    Those, primarily child abuse and rape covering up, corrupt “mental health” industries do have reason to want to hide their appalling, staggering in scope, and ongoing, crimes against humanity. But in reality, the “mental health” workers need to get out of the pedophile and child sex trafficker aiding, abetting, and empowerment business instead, because that multibillion dollar business is destroying all of Western civilization.

    It may be true that the “mental health” workers “can’t handle the truth.” But it is knowing “the truth,” that “will make you free.”

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  6. “RCTs often only show the efficacy of a treatment for the average patient without considering the individual clinical presentations of different patients.”

    It’s slightly worse than that, RCT’s compare “addicts” or “dependents” in withdrawal with some other drug with essentially the same active components. The simple truth about the purported efficacy of antipsychotics is dopamine D2 blockade, that’s it. There’s nothing average about someone experiencing withdrawal from a dopamine blocker. I’m being generous, by leaving out the withdrawal effects of all the other chemicals that were being blocked …

    Meta-analysis are just a collection flawed and biased RCT’s …

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    “Intellectual stagnation” is core to what is hindering everybody who’s anybody—client, researcher, clinicians, and more.

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  8. Let’s talk about voices. Voice is an interpretation of sounds.
    Silencing of voices implies certain level of isolation.
    To give voice to disparate and disagreeing sources implies wide variety of sounds.
    So there is a certain disagreement.

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