Michael Sharpe skewered by @JohntheJack on Twitter

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.

 

Right, but with the caveat that much of psychopsychiatry belongs in alternative medicine.

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.

Love this comment!

 

Did I read correctly?

£300?! Over 12 months?! That's nothing. And for this sick people are being plagued? The study alone was probably more expensive than the "savings" that can be made by using CBT.

 

I

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.

 

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.

 

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.

 

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.

 

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.

 

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.

 

@Robert 1973 made that general point, although without specific examples,
https://twitter.com/user/status/1006887875533852672

 

Sterling work. @Robert 1973

(And thanks for the book, which should be home soon.)

 

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.

 

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.

 

I was impressed that you remembered! Hope you enjoyed it.

Meanwhile, Mike Godwin’s responses are encouraging:
https://twitter.com/user/status/1007034297746903041


https://twitter.com/user/status/1007031757135339523


https://twitter.com/user/status/1007034552827695104

 

[deleted for tact]

 

I do hope folks will let him go now. Am starting to worry that we're living up to our reputation as generally-to-be-avoided because we are so "vehement" and "unreasonable".

 

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.

 

I read your review - thanks, it was great! I've been meaning to look at the book for ages, but the size of it was a bit daunting.