These days the term “evidence-based medicine” is tossed around to the point where it loses any meaning. In conversations about virtually any topic in psychiatry and clinical psychology, the term spills out as a knee-jerk, or more appropriately, mouth-jerk, reaction. The speaker seems to feel that he or she has stated something profound. Meanwhile, those expressing it rarely consider the quality of the evidence that medicine is based on. In areas of medicine where there are hard endpoints such as blood pressure, research by the pharmaceutical industry itself reveals 80% of even top tier lab results are false, and these appear in top medical journal. In psychiatry and clinical psychology, with very soft endpoints such as points on a rating scale, the bias can be far worse. In psychology generally a crisis exists, whereby even top results are not being replicated. In psychiatry, largely due to the capture of the discipline by the pharmaceutical industry, antidepressants results have been presented in a very biased fashion suggesting that they largely suffice for depression and anxiety; forget about psychotherapy. More objective investigations have revealed that the positive impact is far less, such as only 52% of studies showing a benefit. Theory applied to psychiatry and clinical psychology can anticipate and rectify much of the bias that plagues these disciplines, such as showing why combined treatment with medications and psychotherapy is likely to work better, and demonstrating solid mechanisms to diverse psychotherapies, not just a specific type. In the, A Conflicted World: Research Bias chapter of At The Tipping Point: How To Save Us From Self-Destruction, I apply solid theory to demonstrate the extensive bias in psychiatry and clinical psychology, and indicate how we can shift to truly objective evidence based medicine!
Apr 142017