I
n the days when those ancients first disuncovered the rules of logic and logical argument, they must’ve thought they’d found the path to determine absolutes, something like the truth. Alas, it was short-lived, because the senator on the other side of the forum rose and eloquently used those self-same rules of logic and logical argument to reach a diametrically opposite conclusion. And so the march began that lead to laws, the legal profession, courts of law with their judges and juries, our legislatures, etc. – all of those institutions involved in parsing a solution out of h
uman disagreement before warring people end up shooting at each other. And somewhere along this path, there was a new class in the study of logic called logical fallacies – situations where logical arguments are chronically distorted or misused.
I wrote the IOM and sent my blog
back on track… in which I was arguing for Data Transparency being retrospective including the legacy trials [older trials]. But the response suggested that they thought I was being critical of their work [the Institute of Medicine]. Actually, I was tickled pink that they weighed in, but my ending comment was, perhaps, accusing:
So I would encourage Dr. Sim and her colleagues to reconsider playing into this industry manufactured argument and helping medicine get things back on track…
So let me be very public in saying that I was tickled pink that the [IOM] weighed in… and I was further encouraged by this response to another comment:
1bom: …we can look at the raw data from the original trials. And fortunately, the sleight of hand occurred primarily in the analytic and publication processes that came after the blinds were broken. So those legacy trials are the very ones that need to be reanalyzed and meta-analyzed by independent investigators playing with a full deck. Without an accurate and very public re-appraisal, the problem is going to be perpetuated for decades.
response: The IOM report fully endorses this type of reasoning for prioritizing the sharing of certain legacy trials. It just wasn’t up to our committee to call out which legacy trials in particular, or to propose a process for prioritization.
But in thinking about all of this, I realized that my argument flies mighty close to one of those logical fallacies I was mentioning – a special pleading. It’s one of those fallacies our poor judges have to listen to day after day. It goes something like this: "I know that the law says «something the law says», but it doesn’t apply to me because «something their lawyer made up to say»." And, if I’m honest, I’m really arguing that although I can see why subject confidentiality might concern the committee in releasing individual patient data, the legacy Clinical Trials in psychiatry are a special case that justifies whatever measures are necessary to protect subject confidentiality and make that data available to independent investigators. I’m arguing that the distortion of scientific data in the psychiatric drug literature was so blatant, so widespread, and so damaging that it needs to be made available to the medical community at large for systematic examination for any number of reasons – at any cost.
The most practical reason is that these medications are in heavy current use throughout medicine and will be for some time to come. Doctors need to know what they’re prescribing and patients need to know what they’re taking. And we don’t. Nobody is going to fork over the money it would take to restudy these drugs, but fortunately, there’s a wealth of raw data from the
pre-blind-breaking parts of these legacy studies that would tell us a lot about what we need to know. The second reason is equally important in the long run. While it’s understandable why regulatory agencies landed on Clinical Trials as a way of certifying both efficacy and adverse effects of drugs, it is obviously a
special pleading of its own that doesn’t touch the depth of knowledge and information gained from clinical experience – something we need to find a way to take advantage of in a better way than we’re doing now. We need to look long and hard at the whole system to make sure this kind of misuse of science is not driving the practice of medicine. What happened in the realm of psychiatric medicines in the last thirty years more than justifies a
special pleading. Here’s what the
Nizor Project [
a resource for understanding fallacies] says about a
special pleading:
"From a philosophic standpoint, the fallacy of Special Pleading is violating a well accepted principle, namely the Principle of Relevant Difference. According to this principle, two people can be treated differently if and only if there is a relevant difference between them. This principle is a reasonable one. After all, it would not be particularly rational to treat two people differently when there is no relevant difference between them."
The pharmaceutical industry took advantage of the subjective nature of psychiatry and the fact that it was poorly supported, unfortunately engaging many in the profession. The effect on patients, the profession, and the drain on available funding for legitimate research efforts is now very apparent. It has happened elsewhere in medicine, but in sheer magnitude, psychiatry is different. Full Data Transparency goes directly to the heart of the problem. Thus, my special pleading…
I agree.
Although I don’t know how you can unfry an egg or get the toothpaste back into the tube.
Well done grasshopper.
Steve Lucas
“Om” is played out. My mantra is “GABA-A”. I chant it over and over while I contemplate the purpose of GABAA-rho receptors.