Jon Jureidini and Leemon MacHenry: The Illusion of Evidence Based Medicine
Hector Warnes’ Comments
Jon Jureidini and Leemon McHenry launched a credible and ethical indictment against the current system that allows pharmaceutical or marketing companies to test its products and rhetorically manipulate the evidence or data for profitably purposes (apparently supporting the same arguments of David Healey, Le Noury and Wood ). The authors found that the difference between what was reported to physicians and what was revealed in the internal documents was alarmingly different. Two Pharmaceutical companies were the center of their objections: SKF research 329 on paroxetine and Forest Laboratory on CIT-MD-18 and SCIT-MD-18 (citalopram and escitalopram).
The authors cited Popper ́s scientific principles to invalidate the above-mentioned research protocols. For the authors there is a clear demarcation between science and pseudoscience. Scientific methods should be subjected to observation, verification and falsifiability. Refutability is the capacity for a theory or statement to be contradicted by evidence. The testable findings could be refuted by experience or further experiments. In other words, the hypotheses not only are capable of being confirmed by evidence by also capable of being refuted by further evidence. Alternative explanations and new findings alter the measure to which evidence supports the earlier findings.
As far as I know medicine is not an exact science (like mathematics, physics, experimental biology). It is an applied science because testing out a hypotheses has too many variables to contend with such as diagnosis, pharmacogenetics, the selection of patients "who are virgin" of drugs, matching of samples, randomizing the distribution, re-testing the results, adequate time, placebo or blind controls, environmental, demographic, sociocultural and the initial conditions of the experiment which are paramount in the research design.
To complicate matters in psychiatry there is a lack of precise biomarkers and over the years the diagnostic validity of many psychiatric illnesses continue to be questioned. The co-morbidities are on the rise. During the time I participated in research I knew who the patient was taking the experimental drug because of its side-effects (although we know that even patients on placebo experience side-effects but different ones). Unlike exact science which is reductionist (lex parsimoniae or Ockham's razor) we are dealing with a unitas multiplex. Ockham's principle refers to the fact that entities should not be multiplied without necessity because the simpler the variables the more testable they are. Unlike a monogenetic disease such as Huntington's Disease most psychiatric disorders are polygenetic (the effects of multiple genes) plus molecular factors, early upbringing, lifestyle, allostatic load of stress and so on.
Drs. McHenry and Jureidini make an excellent point on the biases and abuses of current psychopharmacological research.
Healey D, Le Noury J, Wood J. Children of the Cure: Missing Data, Lost Lives and Antidepressants. Samizdat Health Writers Co-Operativ. 2020.
December 17, 2020