Re: Is Psychology/psychiatry a Science?
From: Myron (lronhubbardisanut_at_fastmail.to)
Date: 11/08/04
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Date: 8 Nov 2004 08:57:54 -0800
> Generally, patients put on trials of new drugs are pretty desperate.
> You think they wouldn't be curious as to whether they're taking a real
> drug or a sugar pill?
Even so, you're ignoring that there are active placebos.
<snip>
> However, the rush is 100% likely when produced by an SSRI and say only
> 50% likely when expected.
An active placebo can produce this "rush" that you're talking about.
> More importantly, the patient should NOT know what drug they might be on
> and hence should not know what kind of "rush" to expect.
All SSRIs don't produce this "rush". In most patients Luvox produces
somnolence, dry mouth and nausea (see
http://www.mentalhealth.com/drug/p30-l05.html).
Your argument relies on all patients experiencing a serotonin syndrome
type rush in response to all SSRIs. Your asumption is false.
> >> And since all serotonin agonists produce similar sensations,
> >
> >No this isn't true.
> <snip>
>
> What you wrote following this statement is true, however I could have
> been more specific and said that all serotonin agonists produce COMMON
> similar sensations: the sensations of increased serotonin reception
> itself.
The incidence of various symptoms varies from SSRI to SSRI. Effexor
-- for example most commonly produces nausea and headaches (see
http://www.mentalhealth.com/). Unless a patient knows about
pharmacology they won't know that they are taking an SSRI.
> Hence any SSRI is identifiable by anyone who's taken the kind of drugs I
> mentioned.
No, they aren't. The incidence and mix of symptoms varies from
patient to patient and SSRI to SSRI. Psychiatrists commonly have to
try numerous SSRIs to find one that a patient can tolerate.
The general public doesn't know about SSRIs, most ravers don't know
that MDMA is a seretonin reuptake inhibitor and ecstasy is very rarely
MDMA on its own, it's typically a mix of MDMA, Ketamine, LSD,
methamphetamine and GBH.
> This is not my aim, it's my suspicion.
Exactly, it's a suspicion. It's not an argument, not a case, just an
assertion.
> Every single medication double-blind methodology that I've read or have
> so far imagined is flawed. Hence my (easily, but as yet unfulfilled)
> request of John M Price PhD.
Based on the premises that all patients
(a) bit into the tablet and tasted the preparation;
(b) always experience a "rush" from all SSRIs;
(c) can accurately distingush an active placebo from an SSRI;
All of your premises are false. Hence your conclusion/suspicion is
false.
> If it wasn't intrinsically flawed then life would be a lot easier. We'd
> still have to discard 40+ years of research and invent new protocols,
> but think about this:
>
> All drugs are tested against placebos in the US. If it's true that all
> placebos are ineffective, then eventually scientists will be forced to
> abandon the idea.
I don't understand how you can suggest the possibility "that all
placebo's are ineffective". Consider the following table:
Treatment-Emergent Adverse Experience Incidence in 4-to 8-Week
Placebo-Controlled Clinical Trials (Percentage)
-------------------------------------------------------------------------
Effexor Placebo
Body System Preferred Term (n=1033) (n=609)
-------------------------------------------------------------------------
Nervous Somnolence 23 9
Dry mouth 22 11
Dizziness 19 7
Insomnia 18 10
Nervousness 13 6
Anxiety 6 3
>From http://www.mentalhealth.com/)
If placebos didn't work then the last column would be a series of
zeros. I don't understand the basis of your suspicion.
> If we cannot exclude the placebo effect, what options does that leave us
> for evidence-based medicine?
Why would we want to exclude the placebo effect. Look at all the
drugs on From http://www.mentalhealth.com/, the column for the placebo
is not one's or zeroes.
> <snip>
> >On the basis of a bias against the pharmaceutical industry and
> >psychiatry.
>
> Can you think of a good reason to NOT test the double blind?
No one is saying that it shouldn't be tested. Whatever can be tested
should (and will) be tested. You aren't approaching this matter with
a spirit of inquiry. Your're denigrating psychiatry and
psychiatrists, psycho-pharmacology and the pharmaceutical industry on
the basis of the opinions of others and litigation. Many studies show
that psychotherapies are about as effective drugs in the treatment of
depression and anxiety (I'll get you the citations if you want them).
Where there is acute disturbance drugs are invaluable. Sedating a
suicidal person and later taking the "edge" from their depression with
a personally suitable SSRI has saved many a life. The "break" that
the drugs give makes it possible to commence some form of
psychotherapy. There is no magic bullet for mental health. The only
people that claim they have the cure for all mental illnesses are some
unhinged NLPers and Scientologists (which are all unhinged).
I know of many, many people that are able to live independently
because of psychotropic drugs. Anti-psychotic drugs are not perfect
and they don't help all patients but for those schizophrenics for
which they quiet the voices that harangue them they are a great gift.
Seeing the look of peace on a schizophrenics face when the
hallucinations have stopped is profoundly pleasing.
> >> Not at all. Scientific method is founded on the double-blind principle.
> >
> >No it isn't. The double-blind method has application only to
> >therapeutic and bheavioral research i.e. where people are the subjects
> >of research, it is not an intrinsic part of the scientific method.
> >Geology -- for example -- relies on the scientific method but doesn't
> >use single or double-blind placebo trials.
> >
> >You are very wrong here David.
>
> Then maybe your own scientific philosophy is lacking. Though don't feel
> bad, most of the scientific community neglects the principle.
The onus is on you to demonstrate how the the double-blind placebo
trial is an essential component of the scientific method.
> And in case the original questioner is still reading...
>
> Whether psychology/psychiatry/NLP is a science depends largely on
> whether you consider science to include subjective phenomenon.
No it doesn't. A field of study is a science if it arrives at the
information it deems within its purview via the scientific method.
> Most
> scientists do not.
The personality inventories such as the MMPI and other standardized
tests that psychology employs commonly rely on reports of subjective
experience.
> Regardless, all efforts must be made to eliminate experimenter (and
> subject) bias where practical. This especially true if you're aiming to
> produce objective results.
That is what science does.
> One way of doing that is peer-reviewed publishing, which as we know
> isn't perfect, especially in the short term.
There is peer-review in science.
> Another is the double-blind, which IS infallible, assuming that the
> experiment design itself isn't biased.
Nothing is "infallible". Even in the absence of bias there are
mistakes, humans make mistakes: samples can become contaminated, the
wrong statistical technique can be used, extraneous influences may not
have been elimiated etc.
You're waffling David.
> Now, whilst this principle isn't always easily implemented, not
> implementing it has led to MANY invalid results across all sciences.
The increase in average life expectancy, the elimination of many
diseases, improved crop yields, supersonic travel and so on suggest
that the scientific method is serving us very well.
> This is as simple as ensuring that the experimenter doesn't know what
> they're testing.
No, sound research design is a lot more complicated than that.
> There was quite a well-publicised case of this regarding Randi's million
> dollar prize. Several scientists came forwards to suggest they'd proven
> that homeopathy worked better than placebo.
>
> Randi made one change to their experiment to ensure that "none of the
> experimenters knew whether they were dealing with homeopathic solutions,
> or with pure water." The experiment subsequently showed no difference
> between homeopathy & water.
>
> http://www.bbc.co.uk/science/horizon/2002/homeopathy.shtml
No David, your misrepresenting this case. The controversy was that
Benveniste (a single scientist) proposed that water had the power to
"remember" substances that had been dissolved in it. Benveniste
proposed this as explanation for how homeopathy could work. It was
this claim that was tested and which Randi oversaw.
No credible scientist -- in any field -- has ever claimed that
homeopathy works. The principles of homeopathy contradict the basic
principles of chemistry. From chemistry we know that if you dilute a
solution enough there won't be any of the solute left. Enter
Beneviste. He argued that although there are no traces of the solute
in the water the water has a "memory" of the solute. Benveniste
opined that it is this "memory" or "trace" is therapeutically active.
The case that you are quoting is a testament to the research and
discovery protocols of the scientific community.
> It's the same reason that being close-minded is detrimental to your
> arguments.
You're being a prig.
> It shows that even if you could get the logic right, you're
> still bound to twist it in favour of your own agenda.
You've twisted several things to suit your strange case against
science and psychiatry.
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