Michael Sharpe skewered by @JohntheJack on Twitter

alex3619 said:
I question that a treatment that is badly received, does not achieve the primary needed outcomes, and makes patients sicker, is better than nothing. I would rather have nothing and some honesty.
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Exactly. Even if a drug had been released for general use, if harms were subsequently reported of non-trivial risks to patients, especially where trialled benefits were at best mediocre, then surely that situation would be challenged. What is it with this arrogance of PACE/BPS.
 
Woolie said:
What you're actually saying is that its superfluous to neurology, psychology, sociology and alternative medicine ;)
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Right, but with the caveat that much of psychopsychiatry belongs in alternative medicine.

Woolie said:
So I get the feeling the medical fraternity as a whole do not think much of the specialty either.
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Yes, this is one of the reasons why many psychiatrists are pushing BPS, to legitimise psychiatry. Ghaemi talks a lot about this in the book that I reviewed.

Woolie said:
In the UK, there's a few psychiatrists I'm familiar with (excluding the BPS ones), and many of them seem to fit a pattern. They're people who always preferred the humanities/social sciences, but they were persuaded to do medicine because its a good living. Then they discovered psychiatry as a way they could revisit their love of speculation, philosophising, ponitification and big words. The looseness and freedom of it all.
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Love this comment!
 
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chrisb said:
Could it possibly be the case that the evidence for it being good for the ill to be employed is that it is bad for people's health to lose employment?
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I suspect the reason is much simpler: the DWP doesn't have to pay so much to people who are employed - full stop. The illness/work/benefit thing is just a decoy, to avoid the illness benefits issue.
 
dave30th said:
"Godwin's law of Hitler analogies" is pretty well-known. That's why Wessely referenced him I guess-
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Except Godwin's law is not a law, its fallacious if you consider it a law. It is however an observation on human nature, in that people get vilified by comparison to the current cultural bugbear ... which for us is still Nazis.
 
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Invisible Woman said:
I am being stupid here? How do factory closure studies solve for reverse causality when by definition all of those workers were well enough to being in full time employment.
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Just because some people will have certain health issues arise if denied the chance to work, does not in anyway translate to people getting healthier if other health issues are preventing them from working in the first place.
 
Woolie said:
In the UK, there's a few psychiatrists I'm familiar with (excluding the BPS ones), and many of them seem to fit a pattern. They're people who always preferred the humanities/social sciences, but they were persuaded to do medicine because its a good living. Then they discovered psychiatry as a way they could revisit their love of speculation, philosophising, ponitification and big words. The looseness and freedom of it all.
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Uhm I have a bit of this in me!

Maybe psychogenic explanations are popular among doctors that are not otherwise allowed to express creativity and act on pure intuition because medicine is so rigidly regulated.
 
alex3619 said:
That is not actually my position. My position is that psychopsychiatry is largely theoretical, and hence unproven and much of it will be wrong. I cannot a priori identify what is right or what is wrong, we need the science, and it does not exist. Further I do not doubt psychology has an impact on disease and coping mechanisms. My arguments lie elsewhere. I do however point out that the notion that mind causes disease, not impacting or modifying but causing, has a history of utter failure in the scientific literature.

One particular point is that we need to separate scientific psychiatry from non-scientific psychiatry and from pseudoscience. Right now its a terrible mismash. Science is the main method we advance knowledge about complex causal issues, and even so it has a real problem with dealing complex networks of inter-relating things. Only sort-of applying science leads to pseudoscience.

Right now there is abysmal pseudoscience being passed off as sound science. That is creating a lot of issues we see in ME.

I would be happier to see psychiatry split into neurology, psychology, sociology, and alternative medicine. Its a confused mismash of these four right now. Even much of biopsychiatry is flawed because the diagnostic categories are mostly theoretical and unstable. Just look how they keep changing. They lack biomarkers or indeed any definitive markers at all. How can you do good science when you are unsure just what problems you are really looking at?
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To me this comes back to what I said a short while back: Psychiatric 'science' is probably, quite literally, hundreds of years behind other medical sciences. I would think this is for a simple and honest reason - human mentality is an extremely challenging area to research and study. So far as that goes, there is nothing wrong in that; for me the huge problem is that psychiatrist don't seem to ever acknowledge that situation, but instead try to blag their way through as being just as knowledgeable and 'scientific' in their subject area as all the other sciences. So instead of working to properly advance their knowledge and understanding, from an understandably and excusably lower base, they seem ashamed of that position, and refuse to accept it. To me it is incredibly childish, and when you have grown-ups behaving childishly in situations where they need to be mature, people get hurt.
 
Barry said:
Psychiatric 'science' is probably, quite literally, hundreds of years behind other medical sciences.
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Maybe not quite that bad, though possibly it is. The underlying scientific philosophy in psychiatry is not critical rationalism, and nearly all other sciences had fully moved away from positivism/verficationism by about 1960, though this started decades earlier, possibly in the 20s. So their philosophical position is not consistent with modern scientific principles.

So they do not care about contrary evidence and work hard to amass large volumes of data they can claim support their views. This data is often low quality and does not prove their hypotheses.

Even vague psychopsychiatric methods could amass some useful data if they used clear objective outcome measures that made a difference. If there is a large effect size with improved work participation, improved objective physical and cognitive capacity, and a decrease in need for medication or social support, then they would have something. Its rare for them to use objective measures though, and like with PACE when they do the results are ignored because they are either poor or the opposite of what is expected.
 
'I know some basics about research methodology, and I've exposed bad research a time or two, but I'm not at all qualified to assess the claims in this particular debate.'

Perhaps someone could tweet to indicate to Mike Godwin that he is fully qualified to assess the claims in this debate. All that is needed is common sense. If you train people to say they are better and then ask them they are quite likely to say they are better - and that does not mean they can go back to work if the results show they did not go back to work. Any reasonably intelligent person can see this - except perhaps someone with a preadjusted agenda.
 
I might also comment that this has nothing to do with agreement about theories of treatment. It is just pointing out that the trials of CBT and GET in ME are incompetent scientifically. Any decent lawyer should be able to recognise this level of incompetence.
 
alex3619 said:
Its rare for them to use objective measures though, and like with PACE when they do the results are ignored because they are either poor or the opposite of what is expected.
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It's as if any finding that contradicts what they "know" must be right, gets dismissed out of hand because they therefore "know" it must be a rogue finding, and as such can just be ignored. Which yet again is much closer to religion than science.
 
Barry said:
Which yet again is much closer to religion than science.
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Its nineteenth century science. It has no place in this century, and needs to be opposed. The comparison with religion does go back a long way though, to Freud.

In physics we might hear some names a little, like Einstein, but we don't have whole sections of physics devoted to, for example, Madame Curie. Its not cultish. I cannot say the same about Freud or a number of others who established their own branches of psychiatry.
 
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large donner said:
"No consensus about aetiology", yet healthcare policy is based purely on the subjective unblinded rantings of a few powerful industry psychiatrists who advise the DWP and private insurance industry and claim that the cause is false illness beliefs that can be cured by CBT and GET even though they have to falsify, change protocols and recovery definitions and spin every study they have done for three decades.

If there's no consensus there should be no recommneded treatments.
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The basis of evidence based medicine is that there doesn't need to be a solid understanding of the underlying condition. There just needs to be high quality evidence of efficacy. Trials that are not controlled, eg are not blinded and rely on questionnaires are not high quality evidence.
 
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