Sunday, July 2, 2023

Pharmaceutical Company Entanglements Cloud the Objectivity of Neuroscientists and Psychiatrists

One of the biggest mistakes that people make considering the conclusions of an expert is to imagine the expert as some objective, disinterested person weighing truth like some impartial judge or impartial jury.  There are all kinds of reasons why an expert may have "skin in the game" so that he is more like a juror who was bribed to reach a particular conclusion. The largest reason why experts lack impartiality is that they tend to be members of expert communities in which particular opinions are expected because of belief and behavior traditions and speech customs in such communities. 

Let's imagine the difference between two experts, Joe and Jack. Existing outside of a community and using his own savings for funding, Joe spends years studying some subject, enough time to become an expert on that topic. But Joe gets no paycheck related to his activity, and no funding from any group tending to encourage him to think in some particular way. Now Joe will tend to reach opinions on the area of his expertise that are impartial and unbiased.  Not dependent on any kind of funding, Joe knows that he can state whatever opinions he wants on his topic of expertise without fear of a negative financial impact. Joe knows he will never face some kind of performance review or committee hearing in which he will be judged by how well he conforms to the belief customs of some community of experts. In this regard I bear some resemblance to Joe, as I have never taken a cent from anyone except for government agencies (for example, things like tax refunds) and employers that paid me long ago for work such as computer programming work. 

Conversely, Jack becomes an expert in a way that leaves him very much an "organization man." Making a big financial investment in graduate school tuition, Jack studies to be a neuroscientist. His progress in getting his Master's Degree and PhD will depend on how well he conforms with the belief customs of neuroscientists who are teaching him. He can't write a PhD thesis defying the dogmas of such people, unless he wants to take a huge gamble. Then, after getting his PhD, Jack faces a long climb up a career ladder stretching from newly minted PhD to postdoctoral research associate to lecturer/assistant professor to reader/associate professor to full professor. His progress up each step will depend on his conformity to the belief customs and speech traditions of his fellow neuroscientists. At each step there are academic committees who reward conformity and punish nonconformity. So how can Jack possibly think of himself as some kind of unbiased judge on matters such as the capabilities of the human brain?  Throughout his ivory-tower odyssey, Jack will be more like a bribed juror than an impartial judge, because Jack will have more and more of a vested interest in conforming to the speech customs of his peers and superiors. 

There's another way in which the objectivity of neuroscientists is tainted: the fact that they need to get research funding that is abundantly available to neuroscientists conforming to neuroscientist speech customs, but scarcely available to those defying such customs.  Where does most neuroscience funding come from? In the paper "Financial Anatomy of Neuroscience Research,"  we read that "pharmaceutical industry and the largest biotechnology and medical device firms accounted for 58% of total funding." What kind of funding would such players fund? Only research based on assumptions that our brains are the source of our minds and the storage place of our memories.  

As for psychiatrists, they are up-to-their necks in pharmaceutical company entanglements. Pharmaceutical companies bombard psychiatrists with literature claiming that certain categories of mental distress can be treated with particular pills. The psychiatrist constantly given such claims will have a temptation to (a) categorize patients in some category corresponding to an available pill, and (b) prescribe such a pill. Often this may involve buying into some underlying assumption that is dubious or controversial. 

Consider the case of major depression. Strongly encouraged by pharmaceutical companies, psychiatrists and neuroscientists for decades pushed a very dubious claim that depression was caused by a brain chemistry imbalance such as a serotonin shortage.  There was never any very good evidence for such a claim. A study analyzing more than 1800 patients who had been brain-scanned stated, "We provide a large-scale, multimodal analysis of univariate biological differences between MDD [major depressive disorder] patients and controls and show that even under near-ideal conditions and for maximum biological differences, deviations are remarkably small, and similarity dominates." 

An article by Bruce E. Levine cites some reasons for thinking the pharmaceutical companies' "yes-men" psychiatrists have failed:

"In 2011, Thomas Insel, director of the National Institute of Mental Health (NIMH) from 2002-2015, acknowledged: 'Whatever we’ve been doing for five de­cades, it ain’t working. When I look at the numbers—the number of sui­cides, the number of disabilities, the mortality data—it’s abysmal, and it’s not getting any better.' In 2017, Insel told Wired: 'I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.' In 2021, New York Times reporter Benedict Carey, after covering psychiatry for twenty years, concluded that psychiatry had done 'little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health—rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use—went the wrong direc­tion, even as access to services expanded greatly' ... In 2022, CBS reported: “Depression is Not Caused by Low Levels of Serotonin, New Study Suggests.” Receiving widespread attention in the mainstream media was the July 2022 research review article 'The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence,' published in the journal Molecular Psychiatry. In it, Joanna Moncrieff, co-chairperson of the Critical Psychiatry Network, and her co-researchers examined hundreds of different types of studies that attempted to detect a relationship between depression and serotonin, and concluded that there is no evidence of a link between low levels of serotonin and depression, stating: 'We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.' "

In a recent paper a neuroscientist seems to confess the lack of evidence for assumptions that mental illness is caused by brain abnormalities, stating this:

"Yet, despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition. Likewise, functional neuroimaging plays no role in clinical decision making." 

Dubious claims of a neurological cause for problems such as depression and anxiety divert people from focusing on the life history causes and social injustice causes and social influence causes of such problems, such as people being poorly treated by others now and in their past,  people being homeless or in poverty largely because of unfair social structures and laws that benefit the rich, people living under threats such as nuclear war, and people living in a society in which materialist professors seem hell-bent on depicting humans as mere accidents of nature or mere epiphenomena of brain chemistry rather than souls who are meaningful participants in some grand divine plan. Acting against all of the evidence, which suggests in a very loud voice that we are physically enormously purposeful arrangements of matter in a purposeful fine-tuned universe, with minds that cannot be explained by such arrangements of matter, our materialist professors act as if they were trying as hard as they could to depict us in the most depressing way, as meaningless accidental animals; and then they think to themselves,  "Why are so many people so depressed? It must be their brain chemistry." 

bad psychiatry advice

Many complain about the arbitrary categories of the "Bible of psychiatry," the DSM, a text that displays a great number of cultural conventions that seem to lack scientific objectivity. Complaining that there is no objective physical test for almost all psychiatric diagnoses (something comparable to a COVID-19 test), the author of a book about misdiagnoses states this:

"DSM diagnoses, they're lists of symptoms created by mental health professionals sitting around a table. They're based on opinions and theories, not hard data, and published in a book. That's all they are. The real danger is that we believe they're something other than what they are."  

Who are the experts who create and update this DSM "diagnosis bible" of psychiatrists? Experts often under heavy influence by pharmaceutical companies. The DSM often tells a dubious tale that is music to the ears of some pharmaceutical company executives, who cross their fingers while wishing that the experts will keep saying that Condition X is objective reality, when the company makes Pill Y claimed to help with Condition X.  Although it does not recommend specific medications, the DSM manual ends up indirectly being a goldmine for the pharmaceutical companies, who return the favor by shoveling money towards the writers of the DSM manual, in forms such as research grants. The pharmaceutical companies profit because they make drugs they claim are treatment for specific conditions listed in the DSM. 

The DSM manual often contains diagnoses that seem like arbitrary social constructs of a psychiatrist belief community or committee, such as describing an alleged disorder called "Social (Pragmatic) Communication Disorder," which the manual characterizes by using vague, wooly terms such as "deficits in using communications for social purposes" and "difficulties following rules for conversation and storytelling, such as taking turns in conversation." On many pages the DSM manual seems to end up medicalizing and pathologizing nonconformity, and on such pages the DSM manual sounds more like something written by some Ministry of Social Conformity rather than something inspired by hard science. 

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