Application and validation of the bodily distress syndrome checklist in a psychosomatic outpatient sample, Wertenbruche-Rocke et al, 2021

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0163834320301730

 

Things is, they don't physically turn up as they are only in the mind of the doctors..

 

Do they have a large Metaphysics Department in Hamburg?

 

The validation process in EBM is a complete joke. Literally: we like what it says therefore it is valid.

Turns out inventing a process to circumvent the scientific method and make it easier to publish nonsense leads to circumventing the unscientific trash being published more easily. By that metric EBM can be considered a success, it made it so easy you can publish anything.

It's like a nostalgic form of pre-science research, like they used to do back in the days before science.

 

Also in my nearest big town, which my GP tried to trick me into making an appointment at by telling me about a great hospital department which specialised in rare illnesses and might just find out what's going on with me. So I called the number he gave me, and the conversation went something like this:

"Psychosomatic clinic?"
... stunned silence ... "I beg your pardon? Did you say psychosomatic clinic?"
"Yes, do you want an appointment or don't you?"
"No thank you."

I have been in hiding ever since. Hopefully that one call wasn't enough for them to open a file on me.

 

What exactly does it mean that you have validated a disease state that may or may not exist and for which there is no objective diagnostic test?

Usually, from reading decades ago, in psych when you validate you validate for consistency, including internal consistency. In other words, do you get the same results, reliably, over time and for most patients? The reality or unreality of the diagnosis is not in question.

Let me be clear, there are many people with diagnoses who have real issues, even life threatening issues. The questions are about the diagnostic entity and labels, and from there about the treatments.

EBM is becoming the new dogma. In particular its very susceptible to insiders changing the goalposts. Externally its vulnerable to medical professionals, not just doctors, who are busy, under-resourced and often overworked, simply accepting what they read in summaries. They do not have the time, incentives and sometimes even skills to evaluate the evidence. EBM is rapidly becoming the new rubber stamp in medicine.

In particular the psychiatric division of Cochrane, from my understanding, is not holding psychiatric research to a high scientific standard. If you do not even have an objective and reliable diagnostic test, how can you be sure that much of the research is about a real clinical entity? Real people are sick and in distress but this does not mean that diagnoses and treatments are always efficacious. These patients deserve better, much better.

I am not claiming this is about ubiquitous failures in psychiatry, but its definitely a major issue. People - the public, public servants, scientists and medical professionals - need to realize that evidence that is not scientific is intrinsically much less reliable.