A critical analysis of Peter Gøtzsche viewpoints concerning drug companies and psychiatric drugs
Editorial Note (JR):
This post was already published on October 1st, 2014 in their original language (Spanish) under the title of: “Cuando un fan de Peter Gøtzsche crítica a Peter Gøtzsche“. During that time, Marc also motivated me to write down and share my own critics to Peter, an invitation impossible to refuse: “Cuando un fan de Peter Gøtzsche crítica a Peter Gøtzsche – Parte 2″. I have to say that I was hesitant about the viewpoints of Peter susceptible to be attacked by counter-arguments and questions, but my main doubts concerned the appropriate language to write my critics. After thinking and ruminating for a while (i.e., two months -to be honest and to stop rationalizing this: I confess it was my procrastination) I decided wrote my first critical viewpoints in Spanish: (i) to reduce the language bias of discussions about healthcare issues, and (ii) to increase the discussion of these concerns in Latin America and Spain.
One major problem that I have seen in debates about psychiatry and pharmaceutical companies is that many valuable sources are only available in the English language (e.g., deadlymedicines.dk – also in available in Danish, madinamerica.com, pharmagossip.blogspot.com, etc). Fortunately, the appearance into the scene of initiatives such as nogracias.eu (Spain) and medicossinmarca.cl (Chile) will certainly attract people from Spanish speaking countries to engage in these discussions, a process which I am convinced will improve the quality of arguments (as well and counter-arguments) and, last but not least (cliché), closing the gap of language bias will certainly increase the exposure of unethical and (as Gøtzsche points out in a compelling manner) the criminal practices carried out by the pharmaceutical companies – obviously in complicity with doctors and their associations.
I still have many things to say about the work of Peter Gøtzsche (as well as many questions to ask), but before continuing writing from the scratch, I had to translate this exceptional post (maybe another procrastination rationalization). Right now (January 17, 13:32 Bogotá time zone) it is about half done, I used Google translate first, I have the original post in Spanish in another window, I also use grammarly (no advertising – but it is a cool app) and think about finishing this post, but I also have more things to write, and my main concern is the overall quality of the translation below, or maybe not?
I have no affinity for the anti-psychiatry movement, but neither towards the pro-psychiatric one. I just think that the foundations of psychiatry are a tale of pseudoscience (or science fiction sometimes – many biochemical myths…) while widespread unethical practices carried out by psychiatrists sponsored (i.e., bribery) from pharmaceutical companies are a crude reality, as well as the deaths, disability & conflicts caused by psychiatric interventions of dubious safety and effectiveness. The participation of psychiatry in shameful historical events (e.g., Aktion T4) and their role as a “though police” to suppress (repress and oppress as well) dissenters and whistleblowers.
I have before declared my conflicts of interests and my own experiences with psychiatry / as well as other experiences described through this blog. Of course, I might be biased.
Will this post make any new points or ideas about the field of psychiatry as a whole? (diagnosis, treatment, ethics, anti-ethics, etc.)
I do think so.
Translation Spanish to English follows:
Critic to Gøtzsche (MC)
Because I read so much praise (which I do not share in full) and criticism (some of which are convincing to me) on Peter C. Gøtzsche viewpoints about the drug industry as well as the figure that he represents, I proposed to Jorge H. Ramirez to publish in his blog my critical viewpoints to the director of the Nordic Cochrane written by the fingers (keyboard) of a fan which considers Gøtzsche a God deserving of statues — unlike those imaginary beings with an animal head and another’s body.
When someone accuses Peter of pharmascolding activities (i.e., anti-industry and anti-drugs), I don’t really see his arguments as against all drugs, not even in the field of psychiatry. In his original paper (Fig. 1) and not modified by The BMJ (Fig. 2).
He said that according to their research could eliminate 98% of psychotropic drugs, and the rest could be used very occasionally and for a short time. What it is very easy to say and little concrete? Speaking to the Council for Evidence Based Psychiatry (CEP):
The explanation is available in his lecture, nonetheless, everything is very chaotic because a woman repeatedly interrupted his presentation. The presentation is available below:
You can see it on page 126 of 209. For data will not know if in your book because I’m waiting for the translation, but you can send an email and try.
I think that labeling someone as “anti” anything (e.g., X,Y,Z) is not a good argument at all, it is neither logical reasoning. You can make better and more constructive criticism instead of cherry-picking a slide of the presentation (number 127 out of 209 – “we need psychotherapy”) when there is also more critical literature about psychiatric drugs.
Why anti-psychiatry exist but not the anti-psychology movement? – Blog Evolución y Neurociencias (original title – post in Spanish: ¿Por qué existe la antipsiquiatría y no la antipsicología?) – By Pablo Malo, MD, Psychiatrist.
Although there are proposals seeking more for opinions instead of data such as the banning of institutionalization and forced psychiatric treatment. Here the author of this blog could also talk about this because a debate that always comes out among certain groups is defining forced psychiatric interventions as torture. I think that the answer is yes because these types of interventions violate human rights, however, I have also read sound arguments justifying these types of interventions as a hierarchical measure to protect the rights (ethical principles) of beneficence and not maleficence (above the principle of autonomy which vanishes by the coercion employed in forced psychiatric interventions) .
One of the fiercest criticisms to Peter that someone could make is confronting him (in direct and in situ) with data about illegal substances asking about the number of deaths. It is very hard on that data with any drug but marijuana highly consumed. A good question could be to ask him:
How many people have died by consuming THC products?
From the text I’ve read from Peter, I think there is a negative bias towards substances penalized by one or several nations, Peter as a scientist should know that this distinction (i.e., “soft” or “hard” drugs) is purely pseudoscientific. And to put nervous we could also say something about this:
Why Peter bothers so much when someone compares the use of ecstasy with riding a horse? (gets in a rage). In this field, I would not look to towards the work of Gøtzsche to clearly stay with Antonio Escohotado given that it shows a lot of individualized denialing, perhaps it would be nice to read a meta-analysis of deaths related to horse riding compared with ecstasy (both activities practiced safely) authored by the Nordic Cochrane group. Surely, it would be nonsense because I’m mentally visualizing your opinion, and dialogue certainly will end up like many who have had this kind of irrational skepticism towards substances labelled by governments due to consensus instead of a bibliography. Moreover, if Peter capitulates and ceases to focus exclusively on the deaths, he might be able to see other potential damages resulting from the two practices mentioned above, it would certainly be interesting to carry out that study. I have doubts as to whether there are more people with horse related injuries than persons affected (physically or mentally) by consumption of ecstasy in a safe and controlled way. Perhaps Peter might reply something like this: “the consequences of a night of partying and consuming ecstasy have to be counted whether or not a medical follow-up”, but it would lose its scientific rigor and it would not be counting the injuries of people who have done the donkey with horses and consulted doctor with a broken leg and it was not accounted as “caused by irrational practice perissodactyle domesticated mammal tetrapod”. But if something happens while you are consuming ecstasy and there are some suspicions they’ll make you an analysis, and although you can lie if they want to intervene (usually by the means of coercion), the patient for his own good usually confess due to the potential of undesirable drug-drug interactions.
On the sentences Peters applies using the style of Robert Whitaker (always with increases in consumption and mortality, which is a pure correlation): I will skip them all (all of these can be subjected by valid criticism). Although the US approach is to start with the epidemiology and go up in the pyramid of evidence finishing with randomized clinical trials (double-blind and controlled with placebo) rarely someone clarify that this relationship simply does not hold and that is a fact of a true association because it suits them well to strengthen their hypothesis (which seems to me that the majority are well justified). I think, today, that with the level of knowledge, epidemiology; studies in animals and things without cause and effect should be left to researchers without advertising their results in non-specialized media (zero publicity by sponsored advertorials). But it’s just my opinion. [(*) Note (JR): I agree.]
Curiously, Peter speaks a lot about fallacies, but in his book “Drugs that kill and organized crime” at the end is one example, one that I had the wrong dis-pleasure of reading during my lifetime. With the amount of data available to argue against the routine screening in healthy people, he cites a case of a colleague who went to a medical consultation to verify a physical anomaly which almost end with a prescription / surgical intervention. After the release history:
This case didn’t started with a medical check-up, it is an example of what can happen if you go to the doctor without severe symptoms:
Excuse me? Just you won Pfizer, GSK, and Big Pharma altogether. This level may not correspond to someone who makes evidence behind attacks accusing them of doing the very thing that made him in his book. And that is why I always advise people to be more critical of those who supporting / communion than with those who you hate or just their opinions are indifferent to you. And when you see something irregular or fall apart, then raise your voice.
In this video:
There is a moment you ask “do you think of the criticisms made concerning him that you are not a psychiatrist.” He answers “Darwin was not a biologist” and that this review is of missed people of arguments and typical of the mafia. I agree with him but most people examples and a autolamida ego of the author (compared with Darwin or other celebrity) are taken when in my opinion it does is show that you can revolutionize a scientific field without belonging to it . My future profession (dietitian) I read more mathematical and people with different professions to which I shall have their own. One when something does not matter who proclaims either to address while display data accompanying his ideas and his whole approach is open and accessible. Many discoveries in the field of microbiology microbiologists were not through, and clearly that did not matter, anyway, and I hope that gives equal in the future. What of “if I saw him I would prescribe patients or not,” many scientists would be interesting (he not only) will put a few days of test persons suffering from “x” or “y” and describe in writing and then upload it possible actions for quedase always accessible and searchable. That would be a work appreciated but think that the absence of working with people not invalidate any investigation or giving less weight to the opinion of someone. When someone says “I see my patients improve them with such drug or practice which” have never understood why then criticize those who prescribe homeopathy. Needless removed specialize in alternative medicine and therapies to cite studies against the effects hold coin!
Whether you have (be quoted and sell books) he explains own interests in many places:
Which has fallen (more deadlymedicines.dk, stories in the British Medical Journal on trying to access all data from Danish Medicines Association when he endangered her public funding being criticized by fellow / as of the same scientific society Cochrane from other countries and have distorted the message for local journalists …) is not small, but that does not disprove the hypothesis. I believe that would be quieter and more money if he had continued in the pharmaceutical industry (where it started) and give thanks for airing many issues that seem outrageous. Yes, in any publication, interview, appearance in media … quote his books again and again and in many published studies directly cited strip books (mammograms, psychiatry, medicine). But note here:
One gets sick of his articles he edited the journals, which denied responses in debates or certain findings as “too breakers” and choice (along with continue publishing) to publish books where you put what out of there. I feel good and I would too. And then you can discuss in the comments of each site if one book or other biases, handled, used wrong methods … but do not stop publishing certain things does not mean they are false. And that knows a lot Uffe Ravnskov on your hard time about criticism of cholesterol and statins.
And there is nothing more to me head. If you have more questions you can capture them here, twitter or email that will be happy to answer them. I think the majority of complaints addressed to it are:
‘Not to be politically correct
-not Have the specialty that criticism (even when he criticizes medicine do not understand that argument)
-for Skew the data and make cherry picking
-for “Alarm” the population citing only harmful issues
I’m not convinced any and often go without data back or hiding behind “my opinion” (as say that conflicts of interest are relational data only). But why do you think yours is more accurate than yours? Where the issue is debatable opinaremos where the data subject concerned “datearemos”. And I will focus on the last of my list.
Has been widely used argument “tú_estás_matando_a_mi_paciente” (appointing the link in the Foreword to the book’s introduction on psychiatry) and apart from having no logical sense because we would still be in the old bloodletting if we could not fault anything, takes the meeting that point of view because it is saying that we can not group something negative cases of scientific aura; who do we have to accompany something negative to something positive ?; that a patient has no right to know the negative data eg mammograms for “security” and not pass off as quacks disappointment of official science. We had just done a discussion generated by this video Naukas:
Where several people (Naia Pereda that is coming out in the video and Manuel Vilches specialist in hospital radiophysics) were supporting data are the data, and there can be “careful in his statement” because no data badly exposed, if not bad exposing forms. And a graph of number needed to treat and number needed to harm or data just released and each its graphics or models can not be exposed “with caution” is made, are set period. But when the debate is attempted for many years. The deaths of people who could benefit from mammography screening but to be meditating but not taken into account the people have overdiagnosed. As people no longer overdiagnosed depression, if not all treated with SSRIs since this psychotropic drug at the time did not convince either psychiatrists or the FDA (read David Healy “The creation of psychofarmacology” Robert Whitaker, Peter Gøtzsche …). Of course, if someone leaves a psychiatric drug without a supervised discontinuation you may die. But above that it is the fault of the complaint are useless? What world are they prostituted both to blame? In my opinion the autonomy of people send and have the right to know the data. Although who knows if now know the truth will have a higher risk of suicide than consume certain inhibitors of kid. But hey, with skill and patience everything is publishable in The Lancet.
To finish: I could be wrong Peter C. Gøtzsche and also to follow as a fan? Yes. For example we may develop in Europe (first world) a mental illness without much population sample where there is a common gene that would make the very patients resistant to drug therapy and had not been detected in studies of the drug companies nor after marketing by independent studies. I always thought it would be very poetically acid in the developing world had for that psychotropic more favored gene for use, since neither it could allow neither have nor the prevalence and incidence is in the developed world (risk factor for many mental illnesses). I made this post for further analysis of this research so characteristic. Make it a fan does not mean you are blinded, but not to accept anything as a counter.