Monday, March 20, 2023

Comments by Marie

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  • To give credence to this study we’d have to assume that adults and children exposed to pollutants have the same characteristics as those who live in areas with less exposure. Yet the article indicates that isn’t the case.

    We can’t demand rigorous proof in psychological drug trials and then accept studies that have severe faults just because they come to conclusions we like.

    And please, do not assume I’m saying we shouldn’t reduce pollutants. Of course we should.

  • Based on what I’ve read on the MIA website brain imaging studies are not in the least bit accurate in correlating with mental illness. So that’s one reason this meta analysis is dubious.

    A second reason for skepticism is the contention that poverty causes mental illness. I’ve seen no proof of this. My immigrant relatives were all poor. They had no more mental illness than the middle and upper middle class people I now know. And, as an aside, I’d bet that the people most hooked on antidepressants are upper middle class women.

  • This poorly designed study is worthless because, as Peter Simons points out, it compared people with mental health problems who received ECT to the general population rather than to people with similar mental health problems who did not receive ECT. This is not particularly surprising because so many studies, especially in psychiatry, are so poorly conceived.

    It’s possible that ECT may help some people. But the procedure, which has been abused and has horrible adverse effects, has not been proven to be effective.

  • Following the suggestions in this article would certainly help improve psychological studies. But reproducibility of studies is a problem throughout research, not just in psychology. One survey, published in the journal Nature, for example, found that more than 70% of researchers have tried and failed to reproduce another scientist’s experiments.

    Another example: Researchers attempted to replicate 193 experiments from 53 top cancer papers published from 2010 to 2012. But only a quarter of those experiments were able to be reproduced.

    The reasons for this failure to reproduce are varied, and debatable, and include not being able to obtain adequate data from the original studies.

  • In my opinion the root cause of medicalization of childhood behaviors is the desire for pharmaceutical profits. Drug companies are not interested in what is causing distress, only in how much money they can make from suffering. And professions, such as psychiatry, that earn money from dispensing drugs support this trend. Finally, I don’t think we can absolve parents, teachers and actually too many people in general who are seeking easy answers from a pill.

  • I have read medical articles in the New York Times for many years. And for many years I’ve been struck by the poor quality of the newspaper’s medical reporting, not just in psychology but in other fields as well. It’s surprising that some of the reporters have degrees in fields that should make them conversant with critical thinking and statistics. But they’re often not.

    In the medical field, too many NYT articles simply regurgitate the conventional and often corrupt thinking of mainstream medicine. Sometimes smaller, less prestigious publications have far better articles on medical topics than the NYT.

  • Actually there is no OVERWHELMING evidence that childhood abuse causes schizophrenia. Certainly, some studies show an association, but most research is flawed and it’s obvious that there are other causes for schizophrenia than childhood abuse, which seems to put too much of the blame for the illness on parents.

    Bad things indeed do happen, and can drive certain people crazy. I knew a man who had a psychotic breakdown because he feared his wife was having an affair and he’d lose his family. But most people facing divorce don’t react that way.

    I also think there’s a huge difference between being pessimistic and realistic.

  • @Patrick, Steve, Jay. First, I’m not advocating for genetic research. I am saying that heredity is probably a factor in mental illness, as it is in many illnesses. Maybe no one has looked into the genetic causes of cholera, but they have looked into genetic causes of numerous disorders including diabetes and breast cancer. I agree there’s no hard evidence that there is a genetic propensity for psychosis. But what hard evidence is there for other causes of psychosis? If someday we have the tools to formulate a complete description of the causes of mental illness, heredity will probably be included. Currently, such tools don’t exist.

    Also, it is very optimistic to believe that we can combat psychosis by changing cultural dislocation, urban environment, family, social, cultural, religious, educational, geographical and political factors. There’s no reason to think this will ever happen.

  • This is an interesting article that points out horrific abuses. But there’s another side to the story.

    My husband is in a memory care center, bed ridden, with dementia, and with numerous physical ailments. He has been in Hospice for about a year and a half. When he was enrolled in Hospice he was close to death and our family was looking into funeral arrangements. The facility he was in was not giving him adequate care. Nursing homes and memory care centers are having a hard time getting enough help. Caretakers, good or bad, are hard to find. The Hospice nurse and her aides gave my husband the care he wasn’t getting (for one thing they treated and cured a dangerous wound on his heel), while offering support to him and to our family. My husband’s physical health improved. Hospice undoubtedly has extended his life. I can’t say enough good things about Hospice. Don’t ask my opinion of the memory care center.

    Now Medicare is threatening to remove my husband from Hospice. If they do, as seems likely, we’ll have to move him to a nursing home and our costs will burgeon.

    So, yes, based on this article, some Hospices are abusing the system. But the system itself is inadequate and there are some excellent Hospices that have filled the care gap.

  • What’s happening in Canada is mirrored in the United States. Pharmaceutical companies donate money to patient advocacy groups, which then support Big Pharma’s positions. Members of these groups complain to regulators, journalists and members of Congress that if pharmaceutical companies are reigned in research will be restricted and patients will die.

    As an aside, some of the media (Wall Street Journal editorial pages, for example) are no more than mouthpieces for pharmaceutical companies.

  • There is no doubt that adverse psychological and social factors are major causes of mental disorders. But I believe some people are more susceptible to having bad reactions to negative life events. So there must be some genetic component. In addition, there may be other factors that impact development of mental disorders, such as disease, anxiety provoking events and drugs.

    The interrelationship among all these things must be extremely complex meaning the DSM is worthless and putting people into mental disorder categories is inadequate for research and discussion.

    We might be able to move forward a little if researchers admitted the limitations of our state of knowledge.

  • The things you blame on capitalism have been found in many different systems and throughout history. Slavery, not just racism, but actual slavery, was common in Ancient Rome and Greece. It exists in many places in the world today. Burnout? I guess you have to have some kind of wealth to have the privilege to burn out climate change? Too many people is probably the root cause. Loneliness? That’s a problem in urban societies. I could go on, but I’m sure you get the idea.

  • Capitalism certainly has had some evil aspects but no more evil than that found in some of the societies you believe the capitalists oppressed. You ask! “ Why can’t systems built upon “cooperation, peace, love, and understanding” be made to work for the betterment of human kind?”. What systems have been built upon cooperation, peace, love, etc? Humans are filled with love, but also with hate, envy, a desire to dominate, and all sorts of other evil traits. And those despicable traits are dominant throughout history and in all sorts of systems.

    So that’s what’s funny about this article: It is simplistic.

  • This article is almost funny. Of course capitalism has huge faults. But so does every other socioeconomic system. Take this comment about “a connection between the poor work conditions of early industrialization and the illness and premature deaths of workers.” Do the authors really think circumstances were better under feudalism, where workers were virtual slaves to nobles.

    Were conditions better under Mao whose policies led to the starvation death of 45 MILLION people? Or do they prefer North Korea?

    Under capitalism in the United States children are educated and most people have health care and housing. Is it perfect? No. But what is.

    I wish MIA would no longer publish articles like this, which are ideological, show little insight and have only a marginal connection to mental health. There are intelligent, nuanced ways to criticize capitalism. This article isn’t it.

  • I don’t see that this study indicates anything. First of all BPD is a dubious diagnosis. How can this DSM created condition be studied when it is such a questionable disorder?

    Then there’s the admission that one of the therapies studied (eTau) included therapists who used “other approaches” to psychotherapy. Can we really trust that the remaining treatments didn’t also use other approaches? Maybe the good therapists just used what seemed to work. And I’m not even addressing the issue of the accuracy of the supposed improvements.

  • Actually a 15% response is not that bad when compared to the benefits of some other drugs. For example, statins, which are widely prescribed, will not extent lifespan or prevent cardiovascular disease for 98% of those without preexisting heart disease. Insulin given to those with type 2 diabetes will reduce blood sugar levels, but a major study showed marginal non statistically significant reductions in heart attacks, strokes, and maybe microvascular disease among those given insulin after 10 years of treatment.

    The point is Americans take numerous drugs whose benefits are minimal or nonexistent. Why this is the case is a good question.

  • That’s not completely true. I worked for pharmaceutical companies. Yes there were people who would do anything to advance themselves and company profits. It was very disillusioning. But there were also people who genuinely wanted to help patients, who were ethical and who would not go along with corrupt practices.

    And let’s not forget that pharmaceutical companies have developed life saving drugs (remember when childhood leukemia was a death sentence?).

  • There’s probably little point in trying to educate the public and doctors about the realities of medicalized psychiatry. That’s because psychiatry has become a religion to people looking to alleviate their distress. You can no more convince people suffering from psychosis or depression that psychiatric drugs are unlikely to help than you are to convince a Christian to abandon their faith.

    The problem is compounded by the fact that some of these drugs do work for some people (not the majority), something Robert Whitaker has acknowledged.

  • Millions of people have left Venezuela to escape poverty, hunger and the collapse of public services. Yet the “mental well-being” of Venezuelans is better than in the US? I don’t believe it.

    Let me just point out that the survey of mental health was done online so how representative is it of the most impoverished people in that country who undoubtedly don’t have access to the internet? In addition surveys in general can be very wrong and online surveys are especially unreliable.

  • Sera, I enjoyed your approach to the NYT article. It’s very creative to look at the comments as a way of showing how hard it is for so many people to accept alternatives to mainstream psychiatry.

    One of the points I made in my comment on the article was that since drug research has resulted in such minimal benefit, maybe funding should be diverted to other things, such as providing housing as well as social and psychological support to the mentally ill, something that was promised when mental hospitals started closing, but never happened to any significant degree.

  • I personally believe that taking an antidepressant during pregnancy is risky. But, having said that, this particular study is flawed. The group of women who stopped taking antidepressants when they became pregnant may be very different from the group that continued. So any conclusions are suspect.

    Frankly, I don’t understand why they even conducted a study with such a poor design. But this is not unusual in psychological research or, actually, in a lot of research.

  • I read the book on the MISTRA study a number of years ago, not the whole thing; I couldn’t get through it because it was so poorly written. I was very suspicious of the study at the time and criticisms I’ve read of it since then, including the one here, have just added to my skepticism.

    My original objections included that the methodology was slipshod, with the author insisting, for example that the twins didn’t exchange information because they understood the importance of not doing so and fully complied.

    Also, the book examined dozens of the twins’ traits. When that many comparisons are made at least some of the positive heritability correlations are going to be due to chance. This was never considered in the study.

    The study was also homophobic: homosexuality was discussed under the heading of psychopathology.

    That a study like this is still given credence indicates, once again, how misguided the field of psychology is.

  • Maybe I’m being overly optimistic (not typical of me), but this latest DMS ploy has generated a lot of anger. Could the psychiatric profession have gone too far?

    Hopefully this will result in more skepticism about psychiatry and make it just a little easier to effect change.

  • Forgive my skepticism. But when Venezuela gets one of the best scores something has to be wrong despite the caution that this reflects internet users. Here’s another possible explanation for these results: People from English speaking countries are simply more willing to SAY they are distressed or struggling than people in other countries.

    I see a political agenda here, claiming that residents of wealthier countries that prioritize individualism and achievement are more likely to be distressed or struggling. Even if the results of this survey are accurate (dubious in my mind), it’s not at all obvious what the cause is.

  • The only issue here, for me, is that if you think people are more mentally disabled today than in the past you have to have accurate statistics. If it’s easier to get disability checks more people may apply. So are people really more disabled or are the disability figures distorted. I don’t know, but if you’re claiming things are worse you should take into account what I just discussed.

  • I have no idea why you would say that life was less oppressive in Ancient Greece. Thirty percent of the citizens of Athens were slaves (there was apparently a bright spot though, flogging was illegal). Parents were allowed to abandon their babies. Others could take them in, but then the child became a slave. Historians say most people in Ancient Greece had a very low standard of living.

  • By faking it, I simply meant that lots of people claim to have disorders that will allow them to receive disability benefits.

    As for exploitation, the nature of work has often been exploitive or whatever you want to call it. The ancient Greeks and Romans, the Inca and Mayan civilizations, the ancient Egyptians all exploited the masses and slavery was common.

    Capitalism certainly has its faults, but most people, today at least, are better off under it than they would have been in, say, Ancient Greece.

  • This article deals with complex issues so I can only touch on a few things.

    First, employers certainly can exploit workers and often do.

    But the worker can also exploit the system ( I’ll concede to a far lesser extent than the bosses). I have no doubt many people claiming mental illness are faking it.

    But my biggest problem is the implication that poverty, discrimination and insecurity are transformed into medical problems to a greater extent than is the case with those who are more well to do. I’ve seen plenty of relatively wealthy people who suffer from depression, misery, anxiety, drug over doses, alcoholism, suicide and psychosis. What proof is there that the poor have any more mental issues than the rich?

    Life is very hard. Certainly wealthier people and people who do not experience discrimination have tremendous advantages. But is better mental health one of those advantages? I’m not so sure.

  • Unfortunately, failing to tell patients about the side effects of any drug is probably common. Physicians also often fail to discuss basic information, like how likely the drug is to help the patient. When doctors prescribe exceptionally toxic drugs like antipsychotics this failure to inform should be considered malpractice. But of course it isn’t.

  • This is an extremely depressing article because the sensible proposals suggested to improve the situation have no chance of coming to pass in the United States. In addition to all the problems listed in the article, we have a Congress that is owned by the pharmaceutical industry. In 2020, for example, more than two-thirds of senators and representatives accepted pharmaceutical campaign money.

    Big Pharma’s money has been well spent. Congress has been instrumental in weakening the FDA by allowing pharmaceutical funding of the agency and compromising procedures to approve drugs and medical devices through measures such as the 21st Century Cures Act.

    Yes, changes should be made. But with so many people and institutions profiting how is that going to happen?

  • I agree with you that psychiatry has little understanding of the mind and confuses it with the brain. But I still think some symptoms like OCD can be included in a diagnostic category even if there are several causes for the symptoms. And a good psychiatrist should be aware that treatments may have to be tailored to the individual. This is the case with some physical illnesses. For example, a stroke could be caused by a hemorrhage or a clot, but both types are called strokes.

  • “A psychiatrist consulting the DSM would likely diagnose someone with checking behaviors …….with obsessive compulsive disorder………In the process, a psychiatrist might find that they also qualify for anxiety, depression, or any number of other comorbidities.“

    “In HiTOP, by contrast, checking behaviors would be treated as just one symptom reflecting a position on a larger internalizing spectrum—a general tendency to experience strong negative emotions that can encompass qualities of OCD, anxiety, and depression simultaneously.”

    This is the problem: Why wouldn’t a person who had OCD feel anxiety or depression or another comorbidity?

    This new way of thinking doesn’t seem any better than the old.

    Eliminating diagnostic categories altogether, as in PTMF, seems a little better, but what about all those who have similar symptoms, as in OCD? Shouldn’t there be a way to capture this?

    Anyway, as long as insurance companies demand diagnostic categories I don’t see the DSM going away.

  • This is an important topic. I absolutely can see censorship of mental health positions that are not popular with certain influential groups. That’s why I’m opposed to censorship of anything that does not defame individuals. I don’t believe that “demoting bad medical information during a pandemic is a necessary strategy for saving lives.” Who is to decide what is bad medical information? The Facebook censors? The FDA? The groups that initially censored anyone who even suggested that Covid may have started in a Wuhan lab? At one time it was bad medical information to claim that many stomach ulcers were caused by a bacterial infection or that radical mastectomy was overused. Today many object to the routine use of antipsychotics in first episodes of schizophrenia? Should they be censored?

    In order to protect unpopular but possibly accurate information we should tolerate points of view which we are certain are false or even possibly destructive. Censorship has already gone too far.

  • I agree with some of the points made here, but I also have problems. There are people who suffer from serious disabilities and maybe illness is not a bad description for their difficulties even if there are no physical causes. For example, someone who is convinced the television news moderator is not discussing trade issues but is really talking about her, in code. Or the man who can’t leave his home because of overwhelming anxiety. One dictionary definition of illness is an unhealthy condition of body or mind.

    The DSM goes too far in its categorizing almost every problem that causes suffering or difficulties in functioning as illnesses. It’s so corrupt as to be almost useless conceptually. But that doesn’t mean that there are no illnesses of the mind. Or if you don’t want to use the term illness what term do you use?

  • I couldn’t get into this article and, frankly, I didn’t read most of it. Spitzer seems to accept that the DSM is a valid way to categorize psychiatric problems. I don’t.

    At one point he states, “this thing that we were influenced by pharmaceuticals is something that I just, I say, is just absurd.” I think all the DSMs reek of pharmaceutical influence.

    In addition, even though I like reading different points of view, I found this interview boring.

  • I’d like to add liar to your list of his misdeeds. Years ago he wrote an article for Medscape and attacked a physician who commented on his conflicts of interest. He blatantly and inaccurately denied receiving any remuneration from pharmaceutical companies. He did this despite the fact that Medscape had listed his conflicts of interest after the article.

    I have no problem with his being fired, though I still think it’s for the wrong reason.

  • Many popular drugs do not benefit most patients. For example, without pre-existing heart disease 98% of people do not benefit from statins and statins do not extend lifespan. There’s no adequate evidence that blood pressure medications help people with mild hypertension (under 89/139).

    I don’t think most people understand the limited benefit of many treatments physicians frequently prescribe.

  • I shouldn’t be surprised at all this, but the extent of the corruption is so mind boggling it’s stunning.

    One aside, the diagnoses the patient received are uninformative: PTSD, bipolar II disorder, alcohol use disorder in full sustained remission, cannabis use disorder, and borderline personality disorder. In plain English, he was an unhappy person, who used pot and was once an alcoholic. The DSM categories are even more vague than my description.

  • Yes, in getting these female sex drugs approved the FDA was corrupt and the pharmaceutical industry was devious and deceitful.

    But there is another culprit in this story: Physicians who prescribe an ineffective drug and don’t provide vital information to their patients. Who would take drugs with significant adverse effects after being informed that one of them can be expected to lead to an average of only one additional enjoyable sexual experience every two months and the other to none?

    I don’t know the percentage of doctors who prescribe ineffective and even dangerous drugs, but in my experience it’s not an insignificant number.

  • I’ve known for a long time about the corruption of the FDA, but for some reason approval of this drug was especially, dare I say it, depressing. Maybe it’s because of the blatant disregard for good science and patient welfare without even an attempt to justify a bad decision.

    What can we trust the FDA to do right? Can we even believe its endorsement of the Covid vaccines? Some drugs have helped people, but are these a minority of all those approved?

  • I can’t relate to this article. Why should therapists be more concerned about climate distress than other social distresses? How about too many people in the world distress, too much crime distress, poverty distress, inequality distress, too high inflation distress, too many wars distress, abortion restriction distress. I can go on.

    Therapy should deal with personal distress, like I have a serious illness I can’t get along with my wife, my children are failing in school, I’m depressed, I’m being persecuted.

    If a person is only upset about climate change, they shouldn’t go to a therapist. Become an activist if you want, change what you can, accept what you can’t change. As for therapists, let them decide what social issues they want to get involved in, if any; maybe it won’t be climate change. There are plenty of other challenges we face.

  • I have no doubt that these efficacy graphics are what stick in the minds of prescribers. But the misleading graphics are only misleading if they are not examined carefully and if other data from the studies are ignored. So the question is why are these prescribers (mostly psychiatrists I presume) so readily duped.

    Some of them are probably being bought off. But what about the rest? Are they really so trusting of pharmaceutical companies that they’ll believe whatever they’re told?

  • I have been unimpressed with New York Times reporting on health issues in general, not just psychiatry. The reporters too often rely mainly on pharmaceutical company hacks so that they then exaggerate the benefits of drugs while minimizing safety issues. Frequently they don’t seem to know the difference between relative risk reduction versus absolute risk reduction, and their reverence for studies means they accept them uncritically. Bakalar is one of the worst, although what he did in this article seems to be a new low.

    They sometimes have good health coverage, though Their coverage of the Alzheimer’s drug Aduhelm, for example, was excellent.

  • Excellent information on how corrupt the drug approval process has become. It makes me feel that before taking any drug an individual should do their own research. This is, of course, an imperfect solution because information is not easy to come by or understand.

    But I do have a question. Can a drug really be approved without at least one statistically significant result? The result may be for a surrogate marker or it may be a fairly insignificant result, but I believe the drug company has to show some statistical significance. Am I wrong?

  • Being affected by a problem is different from linking that problem to mental health. There’s an unfortunate tendency for too many things to be framed as a mental health issue. It’s one of the ways psychiatry has insinuated itself into all aspects of society.

    I have a vision (or is it a nightmare) of the next issue of the DSM adding a disorder called youth climate change anxiety.

  • I had a very hard time relating to this article. I really think health professionals have more important things to do than address climate change. I’m sure young people are unhappy about global warming. But how about their distress at Covid lockdowns, gun violence, incompetent therapists, over medication for such things as depression and ADHD, social difficulties exacerbated by Facebook manipulations, and the excessive burden of student loans.

    I’m not convinced that global warming is a major factor in the mental health of most young people.

  • I read an excellent book a few years ago, Oligarchy by Jeffry Winters, that basically examined how the wealthy in various countries have controlled society from Ancient Greece to the present. Based on this book and my own observations, I doubt that we can overturn any political system enough to take away the power of the financial elites. Revolutions often just replace one group of oligarchs with their rivals.

    That drug companies can be so openly corrupt while aided not only by the medical profession, but by Democrats and Republicans is only one manifestation of the power of the super wealthy.

    I’m not completely pessimistic. Even within an imperfect system we can have better outcomes. We’ve all seen improvements in our country. Some examples are Medicare, the end of segregation, and more equality for women. I suspect, though, that if we did move beyond a capitalist profit system, the results would be different but not better than what we have today.

  • Pharmaceutical companies have to follow a protocol that they submit to the FDA. This protocol is reviewed by the agency and by an Institutional Review Board, which is supposed to protect study participants. The drug company and the FDA collaborate on many aspects of the study.

    Yet the drug companies still sometimes get approval for drugs that are poorly conducted. My question is will adding another layer of reviewers to what is already an extensive process really lead to better trials?

    I agree that making trial data accessible is a good idea, but that it probably won’t happen. Nonetheless, the information already available in published studies often gives us enough information to see whether the trials are well done. Often it’s obvious they’re not.

    I also think the public is generally unaware of the limited effectiveness of many of the drugs they take. I don’t think some people’s reluctance to get a COVID vaccine is because of a mistrust of medicine in general.

  • This is a very good article that points out more reasons to mistrust medical research.

    I sympathize with the author’s desire to try to improve the situation. But I question whether better and objective criteria that will lead to fair quality assessments are possible given the huge profits involved. These profits not only encourage deception, but give interested parties the resources to manipulate public policy.

    I hope I’m being too skeptical and that at least some beneficial changes can be made.

  • There’s no doubt that conservatorship can be abused. But some parts of this story don’t make sense. How did two tax preparers break into a home, steal records and kidnap someone. Why didn’t the police do something? Why wasn’t an attorney called to prevent this miscarriage of justice?

    How was the mother’s entire estate transferred to a step granddaughter in less than a week? In my experience the court system simply doesn’t work that fast. I don’t know what the situation is in California, but in Illinois even someone with dementia can retain an attorney to protect their interests. Why wasn’t this done?

    I could go on. But parts of this narrative really need more explanation.

  • Dr. Gøtzsche presents some good criticisms of the Cochrane review of antidepressants in children. And I think the review should have been far more critical than it was. Specifically, given the lack of credible evidence, they shouldn’t have suggested that antidepressants might sometimes be considered because their findings “reflect the average effects of the antidepressants, and given depression is a heterogeneous condition, some individuals may experience a greater response.”

    But I want to point out that the Cochrane abstract was hardly a resounding endorsement of the pills. It said:

    “Findings suggest that most newer antidepressants may reduce depression symptoms in a small and unimportant way compared with placebo. Furthermore, there are likely to be small and unimportant differences in the reduction of depression symptoms between the majority of antidepressants.”

  • This is an excellent article, but there’s one other thing that I’ve found adds to polypharmacy and that’s the belief that many patients have that every drug they take is beneficial.

    I used to point out to people the non benefit or low benefit of some of their drugs. No more. Many people are convinced their medications are extending their life span or helping them in some way.

    People want something to give them hope in the face of debilitating (or even not so debilitating) disease. No one wants to hear there’s nothing more to be done and US physicians, for many reasons, usually won’t say that. At one time religion or a shaman may have provided hope. Now it’s often drugs.

  • That 20% of health research is fraudulent is shocking. But the problem is even worse because much research, if not outright fraudulent, is misleading.

    Medical research often cites relative risk statistics, for example, which greatly exaggerate the efficacy of a drug. And there are many other ways researchers massage their findings as MIA has often pointed out.

    Just one example, a study on statins claimed they are effective in preventing heart disease in the elderly, but the study combined those with heart disease and those without to come to that conclusion. The researchers also did not adequately address the lack of a mortality benefit, claiming lack of statistical power to do so, something I don’t believe.

  • Government has been coopted by these industries, so it’s not much help.

    It’s not easy to get accurate medical information. Big Pharma has its tentacles into so much. In addition to what’s been mentioned, it influences medical journals, journalists, physicians, and governmental agencies. I don’t want to be too pessimistic though. There are good sites and accurate information out there. Unfortunately many people don’t have the technical or general knowledge to be able to separate facts from propaganda.

  • A very sad story, but the problem is far worse than indicated here because so many medical associations and organizations that supposedly are patient advocates accept pharmaceutical money. Take the National Alliance on Mental Illness (NAMI), for example, which lists pharmaceutical companies as sponsors. NAMI is typical.

    Beware of online medical advice because so much of it could have been written by the PR department of any pharmaceutical company. One (admittedly minor) example is WebMD’s assertion that brain chemicals in people with ADHD may be out of balance.

    It’s not a pretty picture.

  • Racial equity in all research is important, but this article does not confront the major issue: Are drug companies, who will be aided and abetted by the FDA, promoting psychedelics as a way of coopting currently illegal substances in a blatant attempt to increase their obscenely high profits? I’ve already observed a lack of concern about the substantial bad effects of psychedelics on the part of advocates of this new treatment.

    I also feel legalization is coming because there’s so much money involved. But this concern about including people of color in the research seems to me to be just an additional way of attempting to legitimize a questionable endeavor. Making sure these “treatments” are available to marginalized communities is only fair, but let’s face it, it also increases the number of people the pharmaceutical industry will be able to profit from.

  • Fast track approval has been abused by the FDA and, as this article points out is often based on surrogate markers, like amyloid plaque. Unfortunately many drugs are based on these surrogate markers, not just those that are fast tracked. Examples include cholesterol medications for people without heart disease, which do reduce cholesterol but do little or nothing to increase longevity; and blood pressure medications for mild hypertension, which reduce blood pressure but may have no other benefits.

    I don’t expect the FDA to change its fast track or other approval protocols as long as both Democrats and Republicans are corrupted by pharmaceutical company money and permit such regulatory malfeasance to continue.

  • Incredible, but not surprising.

    I once worked for a pharmaceutical company that submitted a new drug application to the FDA. My boss kept warning that the data was inaccurate, sloppy and unreliable (not all people who work for drug companies are dishonest). She was ignored. The FDA rejected the application and basically accused the company of fraud.

    I observed some other questionable practices, but that was the most egregious.

  • I would just like to add one other major way drug companies fool patients into believing a drug is far more beneficial than it is: reporting the relative risk reduction of a drug instead of the absolute risk reduction. Depending on the study it could appear that a drug is effective 90% of the time, using relative risk reduction, while the more meaningful absolute risk reduction might show as little as 1% efficacy.

    Newspaper articles often present the misleading relative risk reduction when writing about a new drug I think partly because the new drug would seem so worthless they’d have nothing meaningful to write about if they reported the absolute risk reduction.

  • This is the state of too much medical research today: Conducted by people who ignore good science in order to gain financially. Unfortunately the United States government is going along with this sad state of affairs as is most recently evidenced by the FDA’s approval of a worthless, expensive and dangerous Alzheimer’s drug.

  • I read this book a few months ago and basically enjoyed it ( I’ll get to the basically shortly). The novel describes the ways pharmaceutical companies have (among other things) lied, distorted clinical trial results, hidden side effects of their drugs, and attempted to sell medications for all sorts of conditions whether these medicines can help or not. As a former medical writer, I was engrossed by how accurately Scott describes some of the really evil things that are going on. Scott describes the trials and tribulations of a journalist who gets burned when he publicizes some of the wrong doings of a pharmaceutical company. He also follows that company’s guilt-ridden ghost writer as she has increasing doubts about her role in the company’s deceptions. The depiction of those two main characters is decent. But Scott goes overboard in what pharmaceutical companies can do as for example when he lets the chief villain erase all proof of the existence of a main character. No way. My other objection is the jazzy writing style Scott uses. It may not bother everyone, but I didn’t like it. For example, “Yeah, conno-f….ing-rations. Lobster bake-on the beach is going to get us some sunsetty fantasy shots.” Or “Mad honeys, the full Abercrombie.” But for me the pleasure of reading a nicely plotted novel that so satisfyingly exposed the wrongdoings of the pharmaceutical industry outweighed the book’s faults.

  • Of course you’re right. Many common treatments offer no benefits to most patients for whom they’re prescribed. But there’s another factor here. People have an insatiable desire for physicians to do something to help them. What physician would dare say, yes you have a greater risk of a heart attack because of your family history, blood pressure, age, and cholesterol level, but I have no drugs that can help you, or at best there’s only a slight chance the drugs will be beneficial? For many people the medical field and the physician have taken the place of religion and the medicine man. A doctor who refuses to fill this role will lose patients. It’s hard to believe revolutionary change is coming any time soon.

  • There’s no doubt in my mind that the use of psychedelics to treat problems ranging from anxiety to depression to schizophrenia is coming to psychiatry. I don’t think the reason is that these drugs will necessarily be beneficial but because there’s money to be made. The legalization of marijuana has shown that the public may be willing to accept expanded use of psychedelics, drug companies see a new way to cash in on a trend and therapists can try new approaches to mental illness. I can’t say no one will be helped. But some people get relief from antipsychotics and antidepressants even if the hype goes way beyond what the statistics support. Minimized in the discussion for now are all the deleterious effects from psychedelics, including death.

  • Part of the problem are the consumer advocates that attempt to pressure the FDA (of course the drug companies may play a big part in organizing these “advocates”). It has happened before. The FDA approved a Duchenne muscular dystrophy drug in 2016 despite limited data showing efficacy and a negative panel recommendation. There were many desperate parents who ignored the evidence and pushed for approval. And that’s only one example. It’s obvious that the FDA is not always objective.

  • I have lost respect for the Cochrane Review. I recently read their research on maintenance therapy with antipsychotics and was stunned by its poor quality. It’s conclusion: “For people with schizophrenia, the evidence suggests that maintenance on antipsychotic drugs prevents relapse to a much greater extent than placebo for approximately up to two years of follow-up.” It failed to mention the problems with the studies that allowed them to reach this finding. One example, it ignores the fact that patients in the placebo groups have often been abruptly withdrawn from treatment, which could lead to relapse. It claimed long term studies could be difficult to interpret because of such things as environmental factors. I wouldn’t trust anything the Cochrane Review comes up with.

  • Actually I’m not surprised at these findings. How many patients know how to research their doctor’s conflict of interest or understand its importance? Medical journals accept pharmaceutical money and universities have their own conflicts of interest. So their indifference is to be expected. And how many physicians, especially psychiatrists, have an incentive to support tougher laws when they’re benefitting from pharmaceutical grants and gifts?

  • My experience with physicians and SSRIs has not been positive. Years ago a psychiatrist prescribed an antidepressant for my son (for anxiety). He wound up in the ER with the feeling that his whole body was on fire. The ER doctor said it was the SSRI. When my son called the psychiatrist, he said no way it was the drug and wanted to increase the dose. I’ve had two internists over the past 10 years. Both wanted me to take an antidepressant (not for depression). The second doctor was so insistent I lied and told her I’d think about it. You can say change doctors, but I think most of them are that way. Concerning antidepressants, the medical profession abetted by the FDA, has been irresponsible.

  • There is no doubt that antipsychotics are extraordinarily toxic, are over prescribed, and don’t “cure” psychosis. In addition, I have no doubt that few psychiatrists explain the dangers of antipsychotics to their patients, which is nothing less than malpractice. Nonetheless, some people suffer so much from a psychotic condition that antipsychotics may be the only help currently available. Such a prominent psychiatric critic as Joanna Moncrieff, for example, has written, “I still think antipsychotics can be useful, and that the benefits of treatment can outweigh the disadvantages, even in the longterm for some people.”

    Other toxic drugs are prescribed at times because nothing else is available, for example, chemotherapy for cancer. That antipsychotics may have limited usefulness under some circumstances does not mean that they are not misused most of the time.

  • Of course trying to break the blinding of a study is unethical. But I question whether these researchers are also duping the pharmaceutical industry. As I said in a previous post people can improve even when they know they’re taking a placebo. In addition, this study was small and flawed and it’s not clear, to me that the FDA would permit this ploy, at least I hope not.

  • Hopefully the FDA will not accept this devious attempt to break the blinding of a study. But who knows. The FDA has not always acted in the public’s best interests. Also, since it’s been found that people can improve even when they know they’re taking a placebo, this ploy may not work as well as the pharmaceutical industry would like. The study also has serious limits. It was a single blind, very small trial and, according to the researchers, there was no independent monitor reviewing sites’ work. So there may have been “inaccuracies” to hype the results.

  • I know it’s false to claim that only drugs are effective for psychosis, having personally known two people who had psychotic breakdowns , never took drugs and are now doing fine (employed, married, children, friends). One for 20 years, the other for about 8 years. So why does the press ignore studies that show this can happen? Because the press generally reports mainstream points of view, not only in the field of psychiatry but in other health fields as well. Reporters are often not experts in the areas they cover. They’re frequently weak in statistics and interpretation of clinical. trials. They’re also afraid to counter mainstream thinking and established “experts,” fearing they might do harm. I don’t see this changing any time soon.

  • I wouldn’t be too concerned if people don’t want to take statins because they don’t work very well, despite all the hype from the pharmaceutical industry. A study in the BMJ showed that with a statin, death was postponed between 5 and 19 days in primary prevention trials (people without heart disease) and between 10 and 27 days in secondary prevention trials (people with heart disease), with a median postponement of 3.2 and 4.1 days, respectively. Also, the trial mentioned in this article was very small and I’d be curious to know whether the researchers had conflicts of interest. The overselling of drug treatments as being effective, including antidepressants and antipsychotics, is commonplace.

  • I’m not convinced. The most I can say is that there may be some, maybe just a few, adults who do recover memories of childhood abuse, but it’s also possible that many such “recovered memories” are really false. No study cited in this article proves anything one way or another. For one thing, I question the contention that a trusted therapist would not have the same influence as a family member. Therapists can have a tremendous impact. Maybe delayed memory is as reliable as continuous memories, but that’s not saying much because continuous memories are often not that dependable. I truly doubt there are convincing studies of “recovered” memories. In general, most social and psychological research that I’ve seen has not been of the highest quality. The McMartin preschool case should not even be mentioned in a discussion of memory. It was one of the most egregious miscarriages of justice ever perpetrated. And that is one of the major problems of this article. It combines too many disparate cases, McMartin, abusive priests, Sandusky, incestuous parents. The bottom line for me is that nothing in this article proves that the weight of evidence is on the side of a genuine recovered memory vs a false memory when someone makes such a claim. Maybe. Maybe not.