Friday, May 29, 2009

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.


  1. Poor Titmouse -
    A light in the gloom - I read about on my way home today...

    Westminster University had dumped its homeopathy degree.

    From the article:
    "Professor David Colquhoun, a scientist who has waged a six-year campaign against "non-courses", believes the U-turn was due to criticism: "They say that the reason they're shutting it is they haven't got enough students, I think it's more likely to be due to pressure from people like me. I know there are people in Westminster who are embarrassed by it."Looks like causing a stink can have an effect.

    I have looked at Colquhoun's blog and they are still teaching some silly things, but hey, little victories...

  2. Oh, yes, apathy is the answer, eh? When will the shruggies stop shrugging? When pseudoscience is found to be more cost effective for insurers and they find their practices in jeopardy? Sad.

    One good thing: my local TV news program ran a story on the importance of childhood vaccinations. Video of toddlers and babies suffering from whooping cough was included to make a point about a recent resurgence of the disease.

    They featured a mother who had stopped vaccinating her children because she thought one of them had been negatively affected by a vaccine, but then changed her mind when she realized that it may have just been a coincidence and that having her child suffer, or possibly die, from a preventable disease was an unacceptable possibility. I did cringe when she said vaccination should still be a parent's personal choice, and it's unfortunate that the news correspondent failed to mention how that type of personal choices can affect herd immunity, but I'll take what I can get.

  3. How silly can educated people get?

    I suppose it would be illegal to force feed them well over the reccomended doses of quakery to prove its all a load of bollocks?


  4. Hazel...little victories are better than none at all.

    And getting depressed at an APA meeting? That's sad.

  5. Bad enough the battle to get parents to understand quackery when it's after their wallet, but to have the APA unwiling to confront it head-on is just chickenshit. I get it, on the one hand, as it sets a person up and the institution for attacks; Simon Baron-Cohen is currently being eviscerated over at Age of Autism and called a modern Bettelheim, so standing up against it means making oneself a target. On the other hand, if it isn't countered, then their woo-quackery will be accepted by the masses and science will have hope of reaching them.