APA Blues

The American Psychiatric Association meeting in San Francisco this year has left me depressed. The vast majority of my colleagues are either believers or shruggies. Academics I respect and admire feel that fighting quackery is a bad idea.

I related my problem with MDs promoting chelation and other unproven therapies for autistic children to Paul Applebaum. He agreed with my statement to parents, that experimental or unproven therapies must be done in the context of a registered clinical trial so we can learn more about their safety and effectiveness. But when I asked how we as a profession might fight quackery, he shook his head. "I don't know about 'fight'," he said. He seemed to feel that it's enough to limit one's own practice to science-based therapies.

I had a similar conversation with Howard Zonana, who said that there have always been promoters of fringe ideas in medicine. What counts as evidence can be a matter of opinion.

Yes, I said. There are gray areas. But some ideas contradict established basic science. For example, homeopathy-- with remedies so dilute no active ingredient is present-- if it works, we need to re-write physics and chemistry. For that reason we can reject it.

Zonana pointed out that homeopathy was pretty useful in its day when medicines were often quite toxic. He mentioned that the osteopaths, who once held some pretty odd beliefs, have become mainstream.

I started to argue that the shift in osteopathic practice was no natural evolution but the result of the Flexner report.

Zonana interrupted, saying the Flexner report was devastating to a lot of communities. "It closed all the black medical schools. The AMA was politically powerful and really, pretty awful toward blacks."

The implicit point in all this seemed to be: political battles against bad ideas can have unintended, negative consequences.

Chill. Be a lover not a fighter, they seem to say.

And yet Applebaum quite effectively fought against psychiatric involvement in coercive interview settings with military detainees. He said, "not ethical," and snap! Case closed.

Oh, if only. If only he'd take a look at autism quackery and say, "not ethical," in the same way.

Makes me weep. Srsly.