Is tolerance to psychobabble the biggest issue in medicine today?

[chipmunk1]

Haven't read the whole thread, but my answer is no, that isn't the biggest problem. Greed/ the capitalist system of medicine is the biggest problem. The psychobabble doesn't cause harm beyond providing a distraction

I still think that Psychobabble is a huge problem far bigger than most people can imagine.

It effectively allows medicine to remain in the stone age when it comes to certain things slowing down medical progress and leading research in the wrong direction. Decades of potential medical progress have been lost, at least. Probably millions of lives destroyed due to misdiagnosis.

It also leads to dumbing down of patients and doctors. Instead of questioning and critical thinking it promotes random babbling and fantasizing. We can't understand or solve it? No problem let's do some psychobabble.

 

[alex3619]

Haven't read the whole thread, but my answer is no, that isn't the biggest problem. Greed/ the capitalist system of medicine is the biggest problem. The psychobabble doesn't cause harm beyond providing a distraction. Medications that are known to cause more harm than good, but that harm isn't reported to the public until many are sick or dead because there is $$$ to be made, or treatments that are effective kept under wraps because they can't be patented, etc. is much more of a problem, imo.

Economic pressures and politics are part of that. So is the propaganda mill. Any sales based culture will push things based on rhetoric and being able to get away with it. Its the rise of things being seen as good, rather than being good, for society.

The issues with bad pharma are all mostly present in psychopsychiatry. Its psychopsychiatry being tolerated that, in my view, is largely responsible for the huge proliferation in "disease" categories, many of them bogus or inflated or suffering diagnostic creep, that allow drug companies to produce drugs to fix them. Since these categories are unstable, often highly subjective, and with inadequate biomedical research, then there is a huge hole for bad pharma to sail through, as well as bad psychiatry.

Poor medical research practice is a big issue with modern pharma and medicine. Psychopsychiatry has most of these issues, and more. Rigorous evidence based approaches, and not the shoddy and ill-conceived methodology we see in P2P for example, can deal with biomedicine. Psychopsychiatry is not really science, at least its not a scientific discipline, and often lacks even the rigor of pharma.

In terms of pharma the suppression of treatments is not much of an issue in the whole. Of more concern is that nobody researches things that cannot be patented. No profit motive equals no or inadequate research.

Putting it another way, bad pharma sells drugs rather than proving they work. Bad pharma for psychiatry however is selling drugs for diseases that might not even exist. Its not that people are not sick, its that the disease categories are unsafe.

 

[alex3619]

What comes to mind is when I was in college, I knew someone who submitted comics to the university newspaper. I wonder if it would make sense to bring a submission to a webcomic artist... Or have a webcomic artist take up our cause.

There are lots of webcomic tools out there now, many of which are free. I have yet to explore this in any depth.

I think we would self publish. Further, we might want several different comics, each focusing on a different theme.

 

[alex3619]

Bad pharma sells drugs they know don't work, drugs they know kill people, drugs whose side effects are far worse than the symptoms the propose to treat, all for profit, for many diseases known and unknown.

I think there is truth here, but its also deceptively simplified.

Take drugs that do not work. We know now that many antidepressants only work effectively on a subset. Yet they are often handed out almost like candy. Pharma practices have helped obfuscate the issues, yes. However its doctors who have bought claims uncritically, who do not investigate, who do not think for themselves, who make themselves marks for the pharma sales machines to work on. Very often the correct information is published, but the hype that follows overshadows it. We can also see some of that hype in the PACE study publications.

Drugs can kill. So can water, oxygen, starches or doing nothing. This whole thing is about risk management. Which means doctors need good data, and they need to be able to interpret that data. I am aware of studies that over 80% of doctors do not understand basic statistics ... they know enough to pass simple tests, but cannot reason about it. I have not followed this up. Doctors also lack training in critical thinking. Like many modern science degrees, modern medical training is about soaking up facts and learning to apply them. Its about simplistic easy to teach ways to evaluate new research. Sadly most doctors, and this is definitely not always the case, lack the ongoing training and skills in reasoning that would assist them, nor are they encouraged to do this in any way, including through financial incentives.

One thing nearly all doctors lack is an appreciation of the impact of uncertainty. This is not unique to doctors though. Mr or Mrs Average Citizen don't know a lot about various things, and so can have good gut instincts about uncertainty. Experts know lots of stuff, so tend to miss uncertainty. Worse, they then exaggerate to Mr or Mrs Average, convincing them. Embracing uncertainty is a big challenge in medicine. Economists, by the way, are worse for this than even doctors.

Drugs may have side effects that are worse than the symptoms. I have run into this myself. So what? Its not about side effects being worse, but again about risk management. If there is a 0.0001% chance of a bad side effect, with serious downside, but a 90% chance of really good benefit, these two have to be put in perspective. This is about risk/benefit, with size of impact being taken into account. No treatment is certain. What is bad is that the reporting systems for side effects are not great, can take years to lead to conclusions, and pharma public relations will be working hard to downplay any negative issues. Yet in psychopsych there are not even such reporting mechanisms. Its like pharma without correcting mechanisms.

Pharmaceutical companies are for profit. There is no disputing this. Yet much medical research would not occur without their funding. However it does tend to narrow how funding is spent. The only antidote to funding mismatch is public or private funding, such as governments or foundations ... or crowd sourcing. One antidote to hyped research is to take it out of the hands of pharma. They should not be doing their clinical trial research. Heavy regulation is currently in place to try to rein in bias in pharma studies, yet its probably not very successful. Regulation is not always bad, but it has to get the job done. Failed regulation is a double burden ... everyone pays but nobody gets results.

Other avenues for dealing with bias are being explored, such as requirements for publication including pre-registration of study protocols. This might have an impact, we will see.

 

[alex3619]

@JAM, these are all factors related to risk benefit analysis. CFS patient very often have poor drug reactions. Doctors should be aware that various genetic variations and disease and even nutritional states can lead to bad drug tolerance. I almost died from a drug that was thought to be safe ... and I was careful, took maybe 1/10th of a low dose tablet to start with. Go low and go slow is important for starting up new treatments.

FDA is what I mean, in part, about failed regulation. We need them, but we need them to do their job, not kind of do their job. My best guess is the FDA needs to be thoroughly analyzed, then overhauled based on that analysis.

Oxygen sometimes kills people in hospitals. I know of people dying from just water. I can give examples. Its about doctors knowing the risks, and they don't always have enough knowledge to even be aware they do not have enough knowledge.

In 1986 or so I was given something for IBS. Then got new symptoms, then a new drug. Then another bunch of symptoms, another drug. In the end I was put on six drugs, the last one of which causes as a side effect the symptoms of IBS. I researched these, found out the effects, and stopped taking them all. I got better fast after I stopped.

The message is not drugs bad, natural good. The message is there is no substitute for knowledge, and that ignorance often prevails.

Responsibility is distributed too ... doctors, doctors organizations, regulators, pharma, government oversight, and even patients. Its messy, complicated, and the medical system is failing huge numbers of patients. As a system.

 

[alex3619]

I numbered the points I wanted to address, otherwise I can't keep track! lol

I do this quite often, even if its sometimes just mental numbering. We need that to get mental clarity. Isolate something, deal with that, move to the next something. Its often hard for us to think without tricks to enable it.

I was taught to do this in an IT degree, programmers do sequential isolation with software design.

 

[alex3619]

"FDA is what I mean, in part, about failed regulation. We need them, but we need them to do their job, not kind of do their job. My best guess is the FDA needs to be thoroughly analyzed, then overhauled based on that analysis."
Agreed. The problem is how to do that with the inmates running the asylum! lol

Its a principle of good governance that there have to be effective checks and balances. What is happening is a failure of these checks and balances. From what I have seen the IOM and other agencies so far that I am aware of are not competent to overhaul the FDA. I really am not sure what is. That is perhaps the first thing that needs investigation.

There are increasing failures in checks and balances throughout government and associated institutions. This is coupled with a massive decline in effective investigative journalism. Newspapers are going under, and cutting budgets. So the fourth estate (media) are failing to act as balance to government and bureaucratic blunder. The fifth estate, internet, offers hope ... that would be people like us.

Government is increasingly driven by quick fixes and ideology. These have always been issues but I think they are worse now. This is independent of any party ... this is endemic to government, in every country I have looked at, which admittedly is not many. Pave over cracks and leave it to the next government, and hope you are not in power when the whole edifice crumbles!

There is currently no counter to the APA's DSM except the ICD. While the ICD is really just medical codes, I am not entirely sure of the full role of the DSM. I think it makes a claim to strong scientific authority, yet it fails to substantiate that at almost every point. Too much goes on behind closed doors, for example, and is not published and available for criticism.

The CDC and FDA both need to be refreshed ... a total overhaul including directives, regulations and governance. The IOM needs to get its act together. Somebody needs to take a good look at claimed evidence base medicine, and the bad claims need to be thrown out. The role of medical management and medical review need to be separated. There are conflicting goals here. EBMedicine needs to review papers for medical effectiveness based on science. EBManagement is about cost effectiveness, and public policy etc. They are not the same. Conflating managerial practice with scientific medicine is a road to spin, obfuscation, and bad medicine.

Public relations companies should not be allowed to masquerade as unbiased news sources. Churnalism needs to be revealed as shoddy reporting.

There are so many many problems, and they are growing.

Psychobabble has a foot in government, medicine, (arguably not) science, academia, economic interests (including the insurance industry and government), psychiatric associations, medical associations, law, pharma, public relations, and of course treating their patients. Yet they expound their position from a position of claimed authority. The big money earners in pharma are often psych based treatments, which are often not very effective at best, and are targeted at categories they find useful from the DSM. Yet if these categories are unsafe, ambiguous and hyped, who is there to put the checks and balances in place?

The entire medical profession also needs to lose its privileged legal status (which it has to various degrees in many countries) and to lose it right to largely unfettered self governance. Patient rights need to be enforced.

These all require a change in government direction. Governments are failing, investigative media are failing, and we (the public) are failing. I think it was Machiavelli who said "People get the government they deserve." I might be wrong, this is disputed. Milton Freedman, and others, have pointed out that liberty comes from eternal vigilance. So does good governance. Governance is not just about political parties, but the entire structure of government, and even large organizations.

 

[chipmunk1]

1. Drugs can kill. So can water, oxygen, starches or doing nothing.

Deaths from water/starches/oxygen per year? a few, hundreds?
Deaths from prescription drugs? Hundreds of thousands probably.

"The message is not drugs bad, natural good.

In most cases natural is far more harmless than drugs. There are of course exceptions to this.

http://www.nytimes.com/2007/01/16/health/16diet.html?pagewanted=all&_r=0

From 1983 to 2004 there were 230 reported deaths from supplements, with the yearly numbers rising from 4 in 1994, the year the supplement bill passed, to a record 27 in 2005

 

[alex3619]

Agree with most of that, but I think the root of the problem is greed and corporate control of the government. Have you read "Gangs of America"? http://www.amazon.com/Gangs-America-Corporate-Disabling-Democracy/dp/1576753190/ref=sr_1_1?ie=UTF8&qid=1412601698&sr=8-1&keywords=Gangs of America

We agree this is an issue, but not about the scope. There is much more to it than this. So much more that I doubt anyone at all has a really good grip on it.

 

[alex3619]

Deaths from water/starches/oxygen per year? a few, hundreds?
Deaths from prescription drugs? Hundreds of thousands probably.

In most cases natural is far more harmless than drugs. There are of course exceptions to this.

I agree about the numbers, but the real danger is the ignorance. Though I suspect deaths from both drugs and natural supplements are under-reported. I was addressing specific issues in the arguments. In fact, highlighting this actually emphasizes my argument. This is because we know that the risk of deaths from water is low, and here I am not talking about drowning. However under specific conditions it becomes high. How many doctors know how to spot those conditions? Ecstasy is one, it can shut down the kidneys and drive thirst, iirc. Another is heat stress, particularly at high altitudes, with over consumption of water because they are told to keep hydrated by everyone. If the kidneys slow down the water pressure rises in the brain, and they get headaches, then die. A much more rare condition is severe mineral depletion during prolonged water fasts ... nothing but water. Or weird drink two gallons of water a day remedies.

Doctors need to know the relative risk. Sadly, too often, they do not. Even with water or oxygen. Its worse with complex pharmaceuticals, even worse when multiple drugs are involved, and much worse when this is combined with complicated disease or genetics.

So water can be extremely safe. Or extremely dangerous. We need to understand when and why. With drugs, especially new ones, and issues about reliability of many pharma studies, no doctor is going to have a great grip on the issues. That is what reporting of side effects is about. Which brings me back to psychopsych therapy, in which no such reporting mechanism even exists.

 

[shahida]

In terms of psychiatry what Dr Hornig and others (Dr Maes\?) are doing now is to delineate the field- so that person A who suffers from say anxiety or depression might be the one whose psychiatric symptoms are due to physical problems with the brain- and these will be delineated further. But for person B who suffers from (superficially) similar symptoms , however , the root cause for them may well be due to childhood trauma. This i think will uiltimately be the answer and is a battle from within psychiatry itself- Dr Hornig i believe calls herself a psychiatrist yet deals with the former- how psychiatric symptoms are due to various brain diseases. We see this most clearly with Alzheimers don't we. And there's a really good article on this by cort johnson -entitled 'a different kind of psychatrist' about Dr Theodore Henderson- check it out if you havn't already.Here's a quote: 'I approach psychiatry from a brain-based biological perspective.. Most people cannot be pigeon-holed into a single category and most psychiatric conditions are actually a range of disturbed neurobiological processes. - See more at: http://simmaronresearch.com/2014/09...inds-success-antivirals/#sthash.CYdujd2H.dpuf'
I hope that with such work a different narrative will therefore emerge in time.

 

[chipmunk1]

Please cite a source or two documenting psychotherapy causing death (excluding the pharmaceutical related deaths), and a source or two documenting pharmaceuticals causing death. Look at the numbers. They aren't even close

I think most of the real harm is not always so obvious. But looking at the whole mind over matter model:

A significant %(15-40??) of patients are believed to have somatisation disorders instead of real illness.

Which means a lot of patients are being told it's all in your head. There has been research doing long-term follow-ups of cases diagnosed with "conversion disorder" and as far as i recall many of them had serious undiagnosed organic illness and some of them even died. So giving patients a conversion disorder diagnosis instead of treating them can kill them.

I know for sure if i had followed a mind over matter approach my life and my health would suck so much today i don't even want to think about it. I do know of people who tried to solve their health or even their supposedly emotional problems with mind over matter stuff and the long-term outcome was not good in all cases.

Creating a fantasy world(which mind over matter or psychoanalysis essentially is) might be useful over the short-term but long term it's equal to doing nothing. Serious health problems + doing nothing = disastrous long term outcome. In extreme cases it might kill you.

 

[chipmunk1]

CBT is NOT an mind over matter model.

That is what they claim. It derived from that philosophy.

If you use it to treat organic illness it is mind over matter.

Please cite a source for that.

You can read this all the time. I am not making it up but i'm to lazy to look up the research.

http://www.patient.co.uk/doctor/medically-unexplained-symptoms-assessment-and-management

A study of UK general practices reported a prevalence of 18% of consecutive attenders.[4] Studies report that a biological cause can be found for only 26% of the ten most common symptoms presenting in primary care (chest pain, fatigue, dizziness, headache, swelling, back pain, shortness of breath, insomnia, abdominal pain and numbness). Studies from around the world found that 25-50% of primary care patients presented with MUS.[5]

Most people who have a chronic illness and seek therapy are also seeking medical care, it isn't an either or proposition.

Many patients are forced into it:

1. We can't find anything wrong with you and give you a somatisation disorder diagnosis.
2. We deny you all medical care other than psychiatric treatment to not encourage your false illness beliefs.
3. If you complain how sick you feel it's your delusions not your body and we need not listen to you.

Please cite a source that shows that being taught to therapists, or cases of that being used in therapy

I don't think they train therapists to create a fantasy world for the patient. It's actually the entire Mind over matter, Psychoanalysis, Positive Thinking etc. field which seems to live in a fantasy world. They always lived there from the beginning. They do want to encourage sick people to join them though.

Look up some of the studies they do, the history of the field or how the ideas were developed. If this is not a fantasy world what is it then? It is a fantasy world, a religion, a cult etc not sure what the best way to call it is.

 

[chipmunk1]

Again, this is the MEDICAL community, not the psych community.

The medical community get's the idea from the psych field and the psych field validates what they say.

Who is "they"? Because no reputable peer reviewed journal that I have seen has published any of that crap. I have seen peer-reviewed studies twisted to fit the profit model of those behind "The Secret", but never used or taken seriously by the psych community.

Reputable journal has no meaning in psych research.

if you don't believe me please look up the "Critical positivity ratio". You will never call psych research, "research" again. It was published in a reputable peer-reviewed journal.

http://en.wikipedia.org/wiki/Critical_positivity_ratio

How is this not an academic version of "The Secret" for educated intellectuals? Also the psychologists that promoted the idea made a fortune (getting paid $30000 per speaking engagement i think)

it isn't all in my head, but CBT is a tool that helps me control the physical effects of the virus.

I don't believe that CBT can control physical effects of a virus. Maybe some of the effects are not caused by a virus?

It isn't a cure and was never described as one during my treatment, only a tool to help me manage some of the symptoms of my then unknown illness

If it is not a cure why it is being offered to us pretending that it is all we need to live our life?

CBT also helped me get the message that it is all in my head out of my mind after decades of being ridiculed about it by doctors, teachers, and family members

CBT doesn't make us look less foolish in the eyes of others. Quite the contrary. It further encourages the "we are not ill we just don't know how to deal with our emotions" model.

 

[JAM]

I give up. This conversation has become irrational at best. No sources cited and crazy assertions made.

 

[alex3619]

Most people cannot be pigeon-holed into a single category and most psychiatric conditions are actually a range of disturbed neurobiological processes.

This is essentially my own position currently. I think its very rare to find genuine thought-only disorders. Those that exist are about faulty beliefs. But faulty according to whom? Communists are obviously crazy? Or is it those who believe in democracy? Christians are crazy? Or is it the athiests? If you start labeling human beliefs as pathology then you are psychologizing and medicalizing life. That's dangerous. Yet we deprogram people indoctrinated by cults. Hmmm ....

 

[alex3619]

I give up. This conversation has become irrational at best. No sources cited and crazy assertions made.

Please cite some crazy assertions.

Please demonstrate irrational argument.

You cannot claim irrationality if you cannot point to examples.

Someone disagreeing with an argument does not make them irrational. That is an irrational conclusion if that is the case.

Rationality is bound by knowledge. We all have different knowledge bases. What we reason from that knowledge is therefore different.

Its worse than that though. Even rationality is limited by intuition. Our understanding of words, and what they mean, is intuitive - it has very little to do with dictionary definitions. So two people can use the same words, and mean two different things, though usually that is about shades of grey not major differences.

 

[shahida]

This is essentially my own position currently. I think its very rare to find genuine thought-only disorders. Those that exist are about faulty beliefs. But faulty according to whom? Communists are obviou sly crazy? Or is it those who believe in democracy? Christians are crazy? Or is it the athiests? If you start labeling human beliefs as pathology then you are psychologizing and medicalizing life. That's dangerous. Yet we deprogram people indoctrinated by cults. Hmmm ....

I don't know whether thought only disorders are rare- depression in some or many cases may be reactive to a situation,alcoholism, anorexia , these may be primarily thought only in origin which may then precipitate chemical imbalances and such people may be helped by drugs but not cured. But the discipline of psychiatry itself is going to have to have an internal battle to try to distinguish between brain disorders of organic origin and those of the latter. I remember many years ago when schizophrenia was regarded as thought only and people (academics) conducted studies where they looked at where such people lived, found a cluster of schizophrenics living in the same area and proposed 'breeder theory'- ie. they're encouraging each other to become schizophrenic! Totally bonkers. Now we know it;s an organic brain disorder. i think there's more of this to come although no doubt it'll be hindered by those with entrenched positions. Where are those breeder theory proponents now i wonder?

 

[Leopardtail]

I think there is truth here, but its also deceptively simplified.

Take drugs that do not work. We know now that many antidepressants only work effectively on a subset. Yet they are often handed out almost like candy. Pharma practices have helped obfuscate the issues, yes. However its doctors who have bought claims uncritically, who do not investigate, who do not think for themselves, who make themselves marks for the pharma sales machines to work on. Very often the correct information is published, but the hype that follows overshadows it. We can also see some of that hype in the PACE study publications.

Drugs can kill. So can water, oxygen, starches or doing nothing. This whole thing is about risk management. Which means doctors need good data, and they need to be able to interpret that data. I am aware of studies that over 80% of doctors do not understand basic statistics ... they know enough to pass simple tests, but cannot reason about it. I have not followed this up. Doctors also lack training in critical thinking. Like many modern science degrees, modern medical training is about soaking up facts and learning to apply them. Its about simplistic easy to teach ways to evaluate new research. Sadly most doctors, and this is definitely not always the case, lack the ongoing training and skills in reasoning that would assist them, nor are they encouraged to do this in any way, including through financial incentives.

One thing nearly all doctors lack is an appreciation of the impact of uncertainty. This is not unique to doctors though. Mr or Mrs Average Citizen don't know a lot about various things, and so can have good gut instincts about uncertainty. Experts know lots of stuff, so tend to miss uncertainty. Worse, they then exaggerate to Mr or Mrs Average, convincing them. Embracing uncertainty is a big challenge in medicine. Economists, by the way, are worse for this than even doctors.

Drugs may have side effects that are worse than the symptoms. I have run into this myself. So what? Its not about side effects being worse, but again about risk management. If there is a 0.0001% chance of a bad side effect, with serious downside, but a 90% chance of really good benefit, these two have to be put in perspective. This is about risk/benefit, with size of impact being taken into account. No treatment is certain. What is bad is that the reporting systems for side effects are not great, can take years to lead to conclusions, and pharma public relations will be working hard to downplay any negative issues. Yet in psychopsych there are not even such reporting mechanisms. Its like pharma without correcting mechanisms.

Pharmaceutical companies are for profit. There is no disputing this. Yet much medical research would not occur without their funding. However it does tend to narrow how funding is spent. The only antidote to funding mismatch is public or private funding, such as governments or foundations ... or crowd sourcing. One antidote to hyped research is to take it out of the hands of pharma. They should not be doing their clinical trial research. Heavy regulation is currently in place to try to rein in bias in pharma studies, yet its probably not very successful. Regulation is not always bad, but it has to get the job done. Failed regulation is a double burden ... everyone pays but nobody gets results.

Other avenues for dealing with bias are being explored, such as requirements for publication including pre-registration of study protocols. This might have an impact, we will see.

My experience has been the polar opposite of yours. Doctors paralyzed by fear of risk with ME patients and willing to try nothing. But then this is the UK.
For me the bigger issue is wanting too high a degree of certainty combined with ignorance of known side effects.

 

[alex3619]

For me the bigger issue is wanting too high a degree of certainty combined with ignorance of known side effects.

That is indeed a major issue. Indeed the link between this attitude and psychobabble is why I keep looking into irrationality, bias and ignorance.