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Robert J. Hedaya, M.D., D.F.A.P.A., is a Clinical Professor of Psychiatry at the Georgetown University Hospital and Founder of the National Center for Whole Psychiatry. See full bio

A Modern Myth: Medicine as Science: Part II

Does the medical field don the mask of science on a fairly regular basis?

I am waking to the fact that there is a long-term historical pattern of disinformation. Despite the periodic real advances in medicine over the centuries, facts demonstrate that the medical field dons the mask of science on a pretty regular basis.

Here is a brief outline of some additional evidence:

a) There are raging political-economic wars around lyme disease, that have nothing to do with science. The Connecticut attorney General recently removed the mask of science from the IDSA (Infectious Disease Society of America ), ordering this influential and prestigious group to reassess their guidelines for diagnosing and treating Lyme disease because they were selective in their consideration of the evidence, perhaps eliminated some with dissenting opinions from the committee, etc. Because of the IDSA's refusal to look at all the data and pursue the facts, many doctors are losing their licenses as medical boards and insurance companies target physicians who practice outside of the ‘standard of practice'.
b) In the autism wars, via a Freedom of Information Act request, documents have been released clearly showing an attempt by the CDC to suppress data implicating mercury in the steep rise in autism in this country. Aren't they supposed to be on the people's side? Read the transcripts and you will see that some in the agency are clearly on the side of industry, not the consumer. Now, the CDC wears the mask of science, at least part-time.
c) Evidence based medicine (EBM) has been the buzz-word for doctors who have been trained in the last 15-20 years. It's an exciting, attractive concept: weigh the evidence in favor of a certain intervention in a certain disease by looking at all the highest quality studies, then rate the evidence in support of the intervention. Insurance companies love it, because it gives them a way to limit and control treatment. So where is the problem? First of all chronic illnesses, which are the major focus of our health care system, usually do not occur in isolation. The woman who has heart disease generally has insulin resistance and osteoporosis too. Also, because of advances in the field of genetics, we now know that if you conduct a study on a disease-say heart attacks-and don't control for the relevant individual genetic differences, then you have a mixed population in which the intervention could work for a subgroup but not for the masses. The study can be very rigorous (double blind, randomized, placebo controlled) and demonstrate lack of benefit for the intervention, the evidence judged lacking. And that may be true for the group as a whole, ie, on a population level. So if we look at the group as a herd, then public health interventions, and EBM are pretty useful. If we keep most of the herd alive, and only lose a few cows, that's pretty good. But we are not the herd, though we are part of it. We are individuals. EBM, under the mask of science takes population based data and bowing to the power of money, under political and economic pressure applies it to individuals. The mask of science serves the insurance companies very well.

The behavior patterns I have outlined above go far back in time. If you are interested, read "Mad in America". This 400-year history of the psychiatric establishment demonstrates the financial engine, masked as science, which has driven most developments in the field. Roughly fifty year cycles of new paradigms recur: invention, profit, and disillusion regularly re-cur. Almost like clockwork. I suspect we are now at the beginning of the next cycle in psychiatry with the loss of confidence in pharmaceuticals (‘a pill for every ill'). Trans-cranial magnetic stimulation, and deep brain stimulation may be the next wave. There is certainly enough profit in it. I expect to see more talk about these ‘promising new modalities' in the media. Interestingly, in the area of schizophrenia, it is humanistic treatment that has shown the best long term results-not drugs, not shock treatment, not psychoanalysis (nor spinning patients at high speeds, insulin shock, cold wraps, isolation rooms etc.). However this information is not taught in medical school or psychiatric training, just as nutrition is by and large ignored.

I do not think that the alternative medicine field is going to be any better in this regard than the allopathic field. I have seen both alternative medicine and mainstream laboratories putting out inaccurate test results with impunity. I have heard far out, unsubstantiated claims from alternative practitioners. Conflicts of interest are just as prevalent in alternative medicine, only on a smaller scale.

Yet despite these limitations, if I break my arm, or have an acute illness, I want a really good traditional doc. They do a pretty good job with acute illness. And if I have a chronic illness, I want a really good integrative medicine person.

My advice: On a day-to-day basis always be your own doctor-eat well, get enough sleep, exercise, meditate, have fun and build good relationships. When you need to see a health care practitioner you must work hard to be an active and full partner in the process. Learn as much as you can. Investigate, think, and trust your gut and common sense too. Be fully honest with your doctor. No one knows your life like you do. There are good doctors and other health care professionals out there. But you have to keep interviewing to find the one that is right for you.

In the long run, the entire socio-economic system needs to change, because lots of good people are blinded by it, many are hurt by it, and a few narcissistic and or sociopathic people in positions of power maintain it. I think I have some ideas -one practical, and one sweeping and far out. Stay tuned-- in my next blog, where I hope to ‘flesh them out'.


Robert Hedaya, MD, DFAPA
www.wholepsych.com



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