Mike Nova: American Psychiatry At The Crossroads
Last Update: 4:55 PM 5/7/2012
American Psychiatry should broaden its
theoretical and
conceptual outlook beyond the narrow professional concerns about diagnostic systems and classifications (at this time, with all the enormous importance of these issues, we are not ready for the true scientific approach towards resolving them; and the practical problems with "reimbursements" and "parities" should be left for
actuaries and medical records departments to resolve). Recent controversies about DSM-5 indicate that the whole conceptual direction of improving and perfecting diagnostic pseudonosological labeling system (and the professional and social power of labeling that comes with it) hit a roadblock and is in "no exit" blind alley. How can we introduce a true, medically scientific and evidence based classification system for mental disorders if we still know so little about their nature and origins? The attempts to codify the current clinical labels are
methodologically and
epistemologically dangerous because they reinforce the current clinical
belief system with its multitude of misconceptions. The history of
science and medicine in particular is replete with these kind of errors. Preoccupation with improving the reliability by forced agreement (which by itself proved to be impractical and next to impossible) does not affect the much more important issues of
validity of psychiatric diagnosis, and, if anything, leads to their neglect and displacement (not only in psychodynamic, but real sense) from our area of interests and scientific horizons, almost relegating these issues to the province of "conspiracy of silence". How can we agree on something, if we don't really know what this "something" is or if it even really and "truly scientifically" exists? And why should we agree on this "unknown something?"
Medicine and psychiatry are empirical and "practical sciences"; we are not just "talkers" and "labellers"; we are "doers": our task is to ease mental pain and suffering (of which this world is aplenty) for individuals, groups and societies. We do it in the dark, our knowledge is still limited and trues are hidden. We should not reinforce these limitations, presenting "blind spots" as medical facts, but should accept them, be aware of them and work further, relentlessly, and completely with an open mind to resolve them. Narrow professional concerns with "parities and reimbursements" should not be a consideration and should not stand in the way of scientific research and progress in modern psychiatry. This probably was the "primal and original sin" which lead the whole DSM improvement effort astray.
American Psychiatry should assume its rightful leadership role in World Psychiatry with its bold and broad, open and independent minded, scientifically eclectic stance, discarding the outdated stereotypes, not reinforcing them; the stance worthy of this great nation and its spirit.
References and Links:
theoretical and conceptual outlook - Google Search
theoretical outlook - Google
conceptual outlook - Google Search
theory - Google Search
Theory - From Wikipedia, the free encyclopedia
concept - Google Search
Concept - From Wikipedia, the free encyclopedia
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methodology - Google Search
Methodology - From Wikipedia, the free encyclopedia
Methodology is generally a guideline system for solving a problem, with specific components such as phases, tasks, methods, techniques and tools.
[1] It can be defined also as follows:
- "the analysis of the principles of methods, rules, and postulates employed by a discipline";[2]
- "the systematic study of methods that are, can be, or have been applied within a discipline";[2]
- "the study or description of methods".[3]
A methodology can be considered to include multiple methods, each as applied to various facets of the whole scope of the methodology.
Why Most Published Research Findings Are False by
John P. A. Ioannidis
Why Most Published Research Findings Are False
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PLoS Med. 2005 August; 2(8): e124.
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PMCID: PMC1182327
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Copyright : © 2005 John P. A. Ioannidis. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Why Most Published Research Findings Are False
John P. A. Ioannidis
John P. A. Ioannidis is in the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece, and Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States of America. E-mail: jioannid@cc.uoi.gr
Competing Interests: The author has declared that no competing interests exist.
 This article has been cited by other articles in PMC.
Summary
There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. In this essay, I discuss the implications of these problems for the conduct and interpretation of research.
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epistemology - Google Search
Epistemology - From Wikipedia, the free encyclopedia
Stanford Encyclopedia of Philosophy articles:
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belief system - Google Search
Belief system - From Wikipedia, the free encyclopedia
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errors in history of science - Google search
errors in history of science - Wikipedia Search
Philosophy of science - From Wikipedia, the free encyclopedia
Scientific method - From Wikipedia, the free encyclopedia
Pseudoscience - From Wikipedia, the free encyclopedia
Karl Popper - From Wikipedia, the free encyclopedia
errors in history of medicine - Google Search
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http://www.historyworld.net/wrldhis/PlainTextHistories.asp?groupid=474&HistoryID=aa52>rack=pthc
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Influential errors of Galen: His
error, which will become the established
medical orthodoxy for centuries, is to assume that the blood goes back
...
The influential errors of Galen: 2nd century AD
The newly appointed chief physician to the gladiators in Pergamum, in AD 158, is a native of the city. He is a Greek doctor by the name of Galen. The appointment gives him the opportunity to study wounds of all kinds. His knowledge of muscles enables him to warn his patients of the likely outcome of certain operations - a wise precaution recommended in Galen's
Advice to doctors.
But it is Galen's dissection of apes and pigs which give him the detailed information for his medical tracts on the organs of the body. Nearly 100 of these tracts survive. They become the basis of Galen's great reputation in medieval medicine, unchallenged until the anatomical work of
Vesalius.
Through his experiments Galen is able to overturn many long-held beliefs, such as the theory (first proposed by the Hippocratic school in about 400 BC, and maintained even by the physicians of
Alexandria) that the arteries contain air - carrying it to all parts of the body from the heart and the lungs. This belief is based originally on the arteries of dead animals, which appear to be empty.
Galen is able to demonstrate that living arteries contain blood.
His error, which will become the established medical orthodoxy for centuries, is to assume that the blood goes back and forth from the heart in an ebb-and-flow motion. This theory holds sway in medical circles until the time of Harvey.
Read more:
http://www.historyworld.net/wrldhis/PlainTextHistories.asp?groupid=474&HistoryID=aa52>rack=pthc#ixzz1uDtUF4Ls
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16 Feb 2012 by Brennen McKenzie
A brief reference on the web site The Quackometer recently drew my attention to a very short book (really more of a pamphlet, in the historical sense) by Dr. Worthington Hooker, Lessons from the History of Medical Delusions, which I thought might be of interest to readers of this blog. ... However, the focus of this booklet is to illustrate more generally the sorts of errors in thinking that lead even otherwise intelligent and reasonable people to believe such nonsense.
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errors in history of medicine - Pubmed Search
- Performing your original search, errors in history of medicine, in PubMed will retrieve 930 records.
Lessons from the history of medicine.
Source
Lyman Briggs College at Michigan State University, East Lansing, Michigan 48824, USA. Wallerj1@msu.edu
Abstract
What is the point of teaching the history of medicine? Many historians and clinicians find it regrettable that some medical students today will graduate knowing almost nothing of such "greats" of the past as Hippocrates, Galen, Vesalius, Harvey, Lister, and Pasteur. But does this really matter? After all, traditional history of medicine curricula tended to distort medicine's past, omitting the countless errors, wrong turns, fads, blunders, and abuses, in order to tell the sanitized stories of a few scientific superheroes. Modern scholarship has seriously challenged most of these heroic dramas; few of our heroes were as farsighted, noble, or obviously correct as once thought. Joseph Lister, for example, turns out to have had filthy wards, whereas William Harvey was devoted to the Aristotelianism he was long said to have overthrown [1]. But as the history of medicine has become less romanticized, it has also become much more relevant, for it promises to impart useful lessons in the vital importance of scientific scepticism.
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errors in history of medicine - Wikipedia Search
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Errors In History Of Medicine - Topic Review Update from Behavior and Law
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validity of psychiatric diagnosis - Google Search
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- Performing your original search, validity of psychiatric diagnosis, in PubMed Central will retrieve 13290 records.
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Psychiatry (Edgmont). 2005 September; 2(9): 48–55.
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PMCID: PMC2993536
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The Validity of Psychiatric Diagnosis Revisited
The Clinician's Guide to Improve the Validity of Psychiatric Diagnosis
Ahmed Aboraya, MD, DrPH,  Cheryl France, MD, John Young, MD, Kristina Curci, MD, and James LePage, PhD
All from Department of Behavioral Medicine and Psychiatry, Robert C. Byrd Health Sciences Center of West Virginia University, Morgantown, West Virginia
Corresponding author.
ADDRESS CORRESPONDENCE TO: Ahmed Aboraya, MD, DrPH, Department of Behavioral Medicine and Psychiatry, Robert C. Byrd Health Sciences Center of West Virginia University, PO Box 9137, Morgantown, WV 26506-9137 Phone: (304) 269-1210; Fax: (304) 269-5849; E-mail: aaboraya@hsc.wvu.edu
Background: The authors reviewed the types and phases of validity of psychiatric diagnosis. In 1970, Robins and Guze proposed five phases to achieve valid classification of mental disorders: clinical description, laboratory study, exclusion of other disorders, follow-up study, and family study. Objectives: The objectives of this paper are to review what has been learned since Robins and Guze's influential article as well as examine the impact of the new discoveries in neurosciences and neuroimaging on the practicing clinician. Method: The authors reviewed the literature on the concept of validity in psychiatry with emphasis on the role of clinical training, the use of structured interviews and rating scales, and the importance of the new discoveries in neurosciences. Results: Robins and Guze's phases have been the cornerstone of construct validity in psychiatry at the level of researchers. In the absence of the gold standard of psychiatric diagnosis, Spitzer proposed the “LEAD,” which is an acronym for longitudinal evaluation, and is done by expert clinicians utilizing all the data available. The LEAD standard is construct validity at the level of experts; however, guidelines are lacking to improve the validity skills of the practicing clinicians. Conclusions: The authors propose the acronym DR.SEE, which stands for data, reference definitions, rating scales, clinical experience, and external validators. The authors recommend that clinicians use the DR.SEE paradigm to improve the validity of psychiatric diagnoses.
Validity and reliability are two important topics vital to the development of modern psychiatry. Reliability refers to the extent to which an experiment, test or any measuring procedure yields the same results on repeated trials, 1 and is the topic of another paper. Validity is a more difficult term to define because its meaning differs based on the context. Validity, in a very general sense, refers to examining the approximate truth or falsity of scientific propositions. 2 When applied to measuring instruments, validity refers to how well the instrument measures what it purports to measure. 1 When applied to a disease entity, such as bacterial pneumonia, validity refers to the evidence that bacteria is the cause (verified by sputum culture), lung pathology exists (confirmed by x-ray findings), the symptoms (shortness of breath, fever, and cough), and signs (tachpnea, rales) are compatible with etiology and the disease responds to appropriate antimicrobial treatment. In a psychiatric illness, the patient comes with a subjective complaint (e.g., anxiety, depression, paranoia), and the trained clinician elicits signs of the illness through observation of the patient's demeanor, behavior, and thought process. However, there are fewer definitive objective measures (akin to x-ray and sputum culture) that confirm the diagnosis
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text
of the ill person: clinical signs and symptoms are read to ferret out their meaning, the underlying disease. However, I suggest that the hermeneutics of medicine is rendered uniquely complex by its wide variety of textual forms. I discuss four in turn: the 
experiential text
of illness as lived out by the patient; the 
A new study conducted by researchers at Duke University found that the racial composition of jury pools has a profound effect on the probability of a black defendant being convicted. According to the study led by Professor Patrick Bayer of Duke, juries formed from all-white jury pools in Florida convicted black defendants 16 percent more often than white defendants. In cases with no black potential jurors in the jury pool, black defendants were convicted 81 percent of the time, while white defendants were convicted 66 percent of the time. When at least one member of the jury pool was black, the conviction rates for white (73%) and black (71%) defendants were nearly identical. Professor Bayer commented, “I think this is the first strong and convincing evidence that the racial composition of the jury pool actually has a major effect on trial outcomes… Simply put, the luck of the draw on the racial composition of the jury pool has a lot to do with whether someone is convicted and that raises obvious concerns about the fairness of our criminal justice system.” The study examined over 700 non-capital felony cases in Sarasota and Lake counties in Florida and was published in the Quarterly Journal of Economics. 
