What's Wrong With Research In Psychiatry?

The Last Psychiatrist weblog has a decent article on what's wrong with research in psychiatry. Here are some choice bits, with more at the link:

Apart from the high fives, bravado, and binge alcoholism.

Dynastic:

There are no independent psychiatric researchers. Young academics are mentored by older academics; this isn't optional, for either person. In virtually no circumstance do they study something entirely of their own choosing, it is either an outgrowth of the mentors' research, or is the mentors' research.

Groupthink:

Academic psychiatrists are nearly all on the same page, and refer to one another as if they have a relationship, even when they've never met. ("Chuck Nemeroff is doing some good work on...") It's pointless to list the other characteristics of groupthink here, except to highlight one:

the purpose of groupthink is not to promote an ideology, but self-preservation, and this is unconscious. They don't realize that their lives are devoted to preserving the group, yet young researchers are brought on who connect with the group; peer reviewers-- and journal editors-- come from the group; grant reviewers, and NIMH people themselves came from, and support the group.

An example of groupthink preservation is the referencing of studies. Academics support their propositions with previous studies; however, no one checks the accuracy of these studies. No one has the time, and the group necessarily must trust the work of others in the group. Even if an error were to be found, it would be described as an isolated error. A cursory stroll through this site alone suggests just how "isolated" such errors really are.

Outcomes Research Is Purposefully Avoided, or Ignored:

You might think in a field with nothing but outcome studies (e.g. Prozac vs. placebo) I might not be able to make this claim, but I do.

Most studies are short term. The few long term studies that exist (e.g. Depakote for maintenance) are either equivocal (e.g. Depakote for maintenance) or show no efficacy (e.g. Depakote for maintenance.) And they are ignored.

But these outcomes are distractions. The question isn't is Depakote good for maintenance bipolar. The question is, is there any value to the diagnosis of bipolar? In other words, if you called it anxiety, or personality disorder, or anything else, and then treated them ad lib, would the outcome be different? Is there value to the DSM?

You might argue the diagnosis leads us to the treatment, but in most cases, meds are used across all diagnoses, and more often than not a diagnosis is created to justify the medication.

Are hospitals valuable? You would think that by now we'd have a clear answer to this, the most expensive of maneuvers. I can say, however, that reducing the length of stay from several months to 5-7 days has not affected the suicide rate. I'm not saying they are or are not valuable, I am saying that I don't know-- and that's the problem.

It is 2008 and there are more studies on restless leg syndrome then there are on hospital vs. placebo. You know why? See above.

A damning, valuable article