From the President
Psychiatric News
by Jeffrey Lieberman
June 25, 2013
…there were things about it that gave me pause. The tenor and content of the meeting were not as medically oriented or scientifically based as I would have liked. The presentations and discussions got a little too “touchy feely” at times, and the overall focus seemed more on social-science approaches to mental health care than biomedical or neuroscience perspectives. This is not to say that recovery, peer support, counseling, and stigma are not vitally important issues for the enhancement of mental health care quality and access. But health care begins with accurate medical diagnosis and gold-standard treatment — and the whole point of the Mental Health Parity and Addiction Equity Act is to make sure that patients get both medical treatment and supportive services from professionals and peers. I seriously doubt that a daylong government call to arms on other public health problems such as cancer, cardiovascular disease, or infectious disease would have devoted so little time to talking about medical approaches and their scientific underpinnings. I would have liked to hear more about collaborative care models, early detection and intervention strategies, methods of treating medical and substance use comorbidity in people with mental disorders, and the need for more research ranging from translational neuroscience to comparative effectiveness studies…
After thirty three years of listening to matters psychological reduced to touchy feely and care of the sick called social sciences approaches, I’ve grown weary of people like Jeffrey Lieberman, now President of the American Psychiatric Association. When I read things like this, I’m often reminded of the period in my own life when I was in my twenties doing an NIH fellowship filled with phrases analogous to the buzz words in that last sentence: collaborative care models, early detection, intervention strategies, comorbidity, translational neuroscience, comparative effectiveness studies. Fortunately, I was required to practice medicine with real patients learning what physicians actually do, and was appropriately humbled by the experience – developing a new respect for touchy feely and social sciences approaches.
Back in those salad days, I was peripherally involved with a workgroup focusing on the problem of rejection in those early days of organ transplantation. "Matching" was embryonal and the drugs for immunosupression were plenty toxic. We were looking at another angle – how to kill off the T-Cells that mediated tissue rejection. A decade or so later, we all found out what happened when you kill off T-Cells. It’s called AIDS, and it’s not a very good idea. But back then, it was indeed the holy grail – leading edge stuff, novel, innovative.
It’s translational neuroscience that gets to me the most. Literally it means focusing on research that can be translated into clinical use. Keep the eggheads from following their idiosyncratic interests and get them working on things we need. It’s an NIH buzz word picked up by the NIMH’s Tom Insel and the Lieberman/APA set. If you want an NIMH grant these days, you write it up being sure to include how it can be translated quickly into leading edge, novel, innovative treatments. It’s based on the unlikely notion that if you tell scientists what you want, they’ll get right on it and find it. What it can lead to is scientists and researchers thinking about how to get grants rather than following whatever muse leads to real advances. It only makes sense when there’s a clear direction to follow. I wish someone would tally up the results of all those translational grants and funded translational centers to see their track record.
And comparative effectiveness studies sound a lot like clinical trials to me. In psychiatry, we’ve had almost nothing but clinical trials since we went scientific in 1980. Clinical Trials aren’t exactly research. They’re what comes at the end, not where you start. As we all know, clinical trials became one of the conduits for a mammoth pharmaceutical scam escalating for decades in psychiatry – built on the kind of talk we’re hearing from this APA president. And in my reading, this whole article is directed towards focusing what the government does on maintaining the current research programs of Medical School Departments of Psychiatry in the manner to which they’ve become accustomed.
"I seriously doubt that a daylong government call to arms on other public health problems such as cancer, cardiovascular disease, or infectious disease would have devoted so little time to talking about medical approaches and their scientific underpinnings," says Dr. Lieberman. Given the amount of time psychiatry has spent rattling on with its current buzz talk about "biomedical or neuroscience perspectives," I think we’re more that a day behind on the other things. It’s time to catch up and return some balance to the specialty. The false dichotomy Dr. Lieberman is promoting here may well have been appropriate thirty three years ago to correct a genuine imbalance in the force, but that time has long passed. And phrases like "accurate medical diagnosis and gold-standard treatment" in the months after the DSM-5 debacle in an era of huge pharmaceutical settlements just make him sound silly and uninformed…
“And phrases like “accurate medical diagnosis and gold-standard treatment” in the months after the DSM-5 debacle in an era of huge pharmaceutical settlements just make him sound silly and uninformed…”
A nice way to put it. But, what if I have some validity to my point, there is something more dark, and I feel sinister with this man and his organization?
They don’t mind being called silly and uninformed.
You said “I wish someone would tally up the results of all those translational grants and funded translational centers to see their track record.” Well, here’s a start, and the record is dismal.
http://hcrenewal.blogspot.com/2013/04/walk-walk-for-some-time-jeremiad-theme.html
There is a reason for the expression ‘the usual suspects.’
While I’ve been reading here: http://taxonpsych.blogspot.com/
a link jamzo recommended, I’ve been enjoying the way that Roger Blashfield spells out the problems of “comorbidity” very clearly in his talks about the problems with taxonomy in the DSMs. It’s exactly what I suspected the problem to be, but expressed expertly for laypeople.
So I’ve been thinking a lot about “comorbidity” and the bio-bio-bio drive to create categories of biological illnesses using little to no biology, and dismissing human psychology, sociology, and anthropology. And I’ve dismissed it. Completely. I’m comorbidity free now.
So what do our big boy psychiatrists do with their medical education? They seem to have no interest in medical conditions that cause psychiatric symptoms and the rest of the human mind seems not to concern them. Neuroscience is all that’s left. Somehow I doubt that their efforts are going to do much to enhance our lives.
For every person whose life would not be worth living to them without the help they receive from psychiatry, how many persons are convinced that they have a biological malady that they don’t have, are convinced that they need to take drugs for life that make them feel worse, and can honestly say that their lives took their worst turn in a psychiatrist’s office?
Anyone who claims that they want to work in the fields of psychiatry and/or neuroscience for the benefit of humanity who isn’t asking this question is either willfully ignorant, lying and greedy, of very naive.
I think we all know where Lieberman is at.
And let’s not forget that Lieberman has been one of Nemeroff’s apologist. That says it all.
to a non-medical person, it sure sounds like “smoke and mirrors”. I am reminded of those wandering “medical” people touting their cures from the backs of their carts back in the day. But today, we have fancier language.
FYI
Psychiatry, The Pharmaceutical Industry, and The Road to Better Therapeutics
H. Christian Fibiger*
Subsequent to his academic career, Dr Fibiger was Vice President of Neuroscience at Eli Lilly and Company, Vice President of Neuroscience at Amgen, and Senior Vice President and Chief Scientific Officer at Biovail Laboratories International. Parts of this editorial have appeared in NeuroPerspective.
http://schizophreniabulletin.oxfordjournals.org/content/38/4/649.full
http://www.medpagetoday.com/Cardiology/AcuteCoronarySyndrome/40841?xid=nl_mpt_DHE_2013-08-06
Problems Found in PLATO Trial Results
A look at FDA documents revealed concerns about the reliability of the published results of the PLATO trial, which led to the approval of ticagrelor (Brilinta) for patients with acute coronary syndrome (ACS), two investigators said.
….
Also, there was a tendency for sites that were monitored by the drug maker — AstraZeneca — instead of an independent clinical research organization to report more beneficial results for ticagrelor, DiNicolantonio and Tomek reported online in the International Journal of Cardiology.
“The FDA report highlights what appear to be multiple serious deficiencies in the reporting of the PLATO results, which clinicians will not have gleaned from the primary publication alone,” they wrote. “Individual clinicians may therefore wish to carefully reconsider their practice of ticagrelor prescription for this indication. Guideline bodies should also evaluate the information in its totality.”
….
I should have been more careful with my words, jamzo. I can see neuroscientists contributing very much to our understanding of brain and mind, and agree wholeheartedly with the following statement in the article you linked to:
What the field lacks is sufficient basic knowledge about normal brain function and how its disturbance underlies the pathophysiology of psychiatric disease. Because of this, as the record now clearly shows, it remains too early to attempt rational drug design for psychiatric diseases as currently conceived.
Is the term “neuroscientist” wrong? I’ve been ignoring the squiggly red lines until now. For neuroscientist, my dictionary spits out the following: scientist (single and plural), overconscientious, conscientiousness, industriousness, and clarinetist’s.
For neuro-scientist there are all the above except clarinetist’s, plus the following terms: neuron-scientist, neurotic-scientist, neurobiology-scientists, aneroid-scientist, snarer-scientist, neuropsychiatric, and percentage .
The dictionary is amusing at times. Whether they are valid terms or not, I’ve added them to my Office dictionary.
The problem with much of the so called “science” behind psychiatry and many other fields is that we now have scientism to push certain corporate/government agendas to base most if not all studies on blaming the victim theories of bad genes, chemical imbalances of the brain and now faulty brain circuits as the new brain research ideology as announced by Dr. Thomas Insel, Dr. Steven Hyman and many others. The fact the Dr. Insel has announced what the NIMH grants will study and prove in advance shows he is talking about ideology and not science.
The fact that billions of dollars have already been wasted on this futile search for genes which Dr. Jay Joseph exposes as The Gene Illusion and The Missing Gene does not deter the same marketing experts like Dr. Insel to push the latest eugenics agenda on a brain washed public to serve his corporate/government masters.
http://healthimpactnews.com/2013/genetic-research-lacks-science-political-social-control-is-genetics-agenda/
Such a deceitful agenda lets government off the hook and allows corporations to continue to make billions while preying on the victims of this massive fraud and deceit and never having to admit the consequences of their deadly products, pollution and other nefarious deeds. Per the above article exposing that genes and other individual causes contribute almost nothing to various human problems and differences, if government and the population at large acknowledged this, they would have to address the many gross injustices allowed to prevail based on supposed superior and inferior people more or less deserving with the caste determined by one’s fortunate or unfortunate birth.
“we now have scientism to push certain corporate/government agendas”-Florence
Community Mental Health is a matter of enforcement:
https://en.wikipedia.org/wiki/Community_Mental_Health_Act
“The Socially Friendly ” Chapter 16
http://archive.org/stream/Gulag_Archipelago_II/Gulag_Archipelago_II_djvu.txt