I distrust medical studies, especially those run by MDs. In part that is because MDs are not really trained in scientific research, even if they do it. It's like lawyers and scholarship.The law journals are filled with worthless writing for several reasons, one of which is that a J.D., the only qualification required of a law professor, is not a research degree.
MDs take a lot of science classes, but that that no more makes them scientific researchers than taking taking classes in law makes you a legal or any other kind of scholar. Btw, it also doesn't make you a lawyer -- you learn that on the job. As a law professor I sometimes wonder what exactly it is we are doing with the students.
I had a lot of science classes, mostly in physics, some in cognitive science, as part of the background for my philosophy degrees, but that doesn't make me remotely qualified to be a physicist or a brain researcher. Both MDs and legal academics should put warning signs on their work, saying, I'm not a scholar: I just play one in the journals.
That doesn't mean, of course, that MDs and JDs can't learn, or teach themselves, to do excellent scholarly research. It's just that they are not trained to do it. People should really understand this when reading medical studies. Hardly anyone but other academics and law clerks ever read even parts of law review articles, so the main risk to the world from those products is the waste of trees. Medical research is a different story.
I may be a snooty PhD. Actually, I am a snooty Ph.D. I have degrees in philosophy of science and political science* as well as the JD. In addition to the background non-research science courses I took, just like the MDs. I was trained as U-Mich polisci number cruncher to do real research. I do know how to do scientific research, or, at this remove, how to recognize when it's done right.
In addition, the kind of law I practiced at the firms involved lots of working with and demolishing the work of expert witnesses (mostly hired guns). So I do have what the practice of law can give you in terms of the assessment of scientific research, which, from the point of critiquing it, is not negligible.
All this makes me highly skeptical of medical research carried out, as in the main it is, by MDs. Further, there is the factor that a lot of that work is funded by big Pharma (some of my former clients), and that has been shown by reliable research to affect the results. -- Just in case you needed statistical studies to prove what you knew already, you don't bite the hand that feeds you.
That's less of a factor with the work at issue here, where we are discussing an attack on big Pharma.
The risk of bias is not a reason to ignore the research -- but it is a reason to look at it really really hard.
With popular anti-psychiatry or alternative medicine, you run into a related problem of bias. Whether or not the people who this sort of work are scholars, and often they are not; they are journalists or activists, they have a ideological agenda when tempts them to cherrypick the studies that support their theses and ignore the ones that don't, or to interpret the results in the light most favorable to their critiques without squarely assessing the alternative readings.
I underline that I do not think there is any such thing as "objective" research from no point of view carried carried out in a spirit of disinterested inquiry into the truth. Or if there is, it's rare as hen's teeth. But my point here is just that we have be alert to possible sources of bias and error in both official medical studies (incompetence and corruption) and alternative critiques like Let Them Eat Prozac (incompetence and ax-grinding).
I haven't read the book and don't accuse it of any failings in particular. Some of the issues raised by Shag and Carrol sound like they might be good arguments, but I'm not speaking about this book, but about the issues posed in assessing medical research and critiques based on it.
FWIW, and my experience here is personal;, anecdotal, and scientifically worthless, my own brief personal experience with SSRIs (I think the one I took was Zoloft, it may have been Xanax, definitely not Prozac -- this was a long time ago) was that what I took was very effective at mood control, did not, in my case, produce suicidal ideation. It did, however, produce the other well known side effect, discussed, for example, on the Sopranos. For that reason I switched over to a Wellbutrin analog that does not have that effect, but was for me equally effective in controlling moods.
Btw, it would interesting to know if there is any research on whether Wellbutrin and other non SSRI ADs increase suicidal ideation. If not, that would undercut the theory Shag mentions that what SSRIs do is make depressed people undepressed enough to actually start thinking about or taking steps towards suicide. If that theory is correct, any roughly equally effective ADs should have that effect. (See, the basic elements of scientific method, Mill's Method's, identified long ago in by J.S. Mill in his Logic, are still excellent starting points for hypothesis formation and testing.
I will add that in my unscientific opinion, psychiatrists (MDs!) overrely on drugs to deal with people's problems. When all you have is a hammer, everything looks like a nail. I speak as someone who can still feel the crash if I forget my Wellbutrin. For some people, those whose problems are merely chemical, psychotropic drugs may be enough, but I think that for most people with problems, more is required even if drugs are necessary.
Talk therapy can be valuable if you find someone good. In my experience that is hard. There are a lot of therapists out there who are real menaces, far more destructive than constructive. Other kinds of talk therapy, talking the term broadly, the support of real friends, especially if they know you you very well and have a lot of psychological insight and empathy, are even more valuable. I have been lucky that way.
And often we need to change our way of living. At the risk of causing guffaws among the hard-headed materialists here, I myself feel that I started to experience real positive dramatic changes beyond what good therapists and caring friends offered (which was a lot) when I began to practice Zen and yoga in a serious way. I'm not saying these disciplines are for everyone, just reporting my own experience.
And no, I'm not getting hippy-dippy in my middle age. (Did that as a teenager already.) Quite apart from the fact that I still dress like a big firm lawyer in high end men's clothes, there's nothing new agey about my very traditional teachers of the ancient practices. Well, my yoga teacher has a streak of of that -- but he insists on rigorous discipline and constant practice. Serious Zen is about as antithetical to New Agery as anything could be. There is also "real" Western scientific research that Zen practices have very positive psychological effects, but the real test is what you experience when you do it. Doing these things has been transformative for me, and the only thing I can say is that others may so find if they make the commitment. But they're hard But I only mention these as examples of two of of the many ways one can change one's way of living for the better in ways that drug-based psychiatry can't do.
OK, that's enough for now.
Andie
* [You can tell I'm a legal academic -- even my list contributions have footnotes.] OK, I know that polisci and quantitative social science generally is something like cargo cult science -- a cruel but not wholly inaccurate slur by the great physicist Richard Feynman. You set up the apparatus and wait for the science to fly in. However, there's a core of it that is really good, and it's the only semi-controlled check we have on the risks of uncontrolled subjectivity in case study work or (worse) partisan punditry. And there's is no possible way to make the study of human behavior as mathematically rigorous and experimentally testable as physics. You do what you can within the limits of your material. (Paraphrase from Aristotle.)
--- On Sun, 9/27/09, shag carpet bomb <shag at cleandraws.com> wrote:
> From: shag carpet bomb <shag at cleandraws.com>
> Subject: Re: [lbo-talk] let's argue about the cause of mental illness
> To: lbo-talk at lbo-talk.org
> Date: Sunday, September 27, 2009, 1:59 PM
> At 11:48 AM 8/27/2009, Bryan Atinsky
> wrote:
> > A neighbor of my sister is a doctor at a psych
> hospital north of Tel Aviv, and not too long ago I got into
> a discussion with her (the doctor) about this relationship
> between SSRIs and suicidal ideation and behavior. She said
> that she thinks it isn't really the medication that creates
> the ideation, etc., but that many severely depressed
> individuals, the ones at least that she sees in her
> hospital, are too depressed to act on anything, let alone
> suicide, and can't really be counseled.
>
>
> I've been reading Let Them Eat Prozac, which is by David
> Healy, parts of which are online. In it, I came across
> references to research that Lilly tried to heavily suppress
> WRT Prozac: suicide ideation among non-depressed people.
>
> Lilly, and I assume other drug companies, when sued by
> survivors of people who'd taken SSRI's and then gone on
> murderous and suicidal rampages used a strategy of blaming
> the disease instead of the drug. At least in the Forsythe
> case against prozac, one Doug posted about here way back in
> 1999, Lilly worked hard to keep that evidence out of the
> courtroom since it was good evidence for pinning it on the
> drug, not the disease. Also in chapters 5 and & of Let
> Them Eat Prozac, there's a discussion of the fact that it
> was mildly depressed folks who, upon taking SSRI's, are the
> ones who suffered most from suicidal ideation most. These
> are folks who are totally incapacitated and, in fact, are
> folks who aren't hospitalized and don't need to be.
>
> shag
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>