The Science Isn’t There

In my December 2011 post on “Nutrition and the Argument from Uncertainty” I cited and applauded the work of science writer Gary Taubes for unearthing the truth about nutrition science. The upshot was that the science just isn’t there for the conventional wisdom recommending a low fat diet and lots of exercise to protect us against obesity, diabetes, and heart disease. The science instead shows sugars and starches to be the most likely villains.

In a remarkable similarity of investigative journalism, science writer Robert Whitaker, in Anatomy of an Epidemic, demonstrates that the science isn’t there either for the chemical imbalance theory of biopsychiatry. In fact, the evidence in the psychiatric profession’s own literature shows that drug usage for depression, anxiety, and so-called schizophrenia causes more harm than help. In place of a genetic or chemical imbalance theory, Whitaker cites numerous studies supporting psychosocial issues as the causes of psychological problems and psychosocial treatment as the preferred technique to help victims of such problems improve.

To begin the presentation of Whittaker’s argument, let me repeat a point from last month’s post in which I reviewed his earlier work Mad in America: in the pre-drug era of the 1930s and ‘40s analysis of 1400 autopsied brains found no differences between the normal and the psychotic. Given this statement as a sort of prelude, what does Whittaker’s new book say about the chemical imbalance theory?

The theory for both depression and schizophrenia, as it has been tendered by the psychiatric profession, is quite simple. For depression, there is too little serotonin in the brain; for schizophrenia, there is too much dopamine. The drugs, therefore, according to the theory, should increase serotonin to combat depression and reduce dopamine to treat schizophrenia. Measurement of these neurotransmitters in cerebrospinal fluid is the benchmark for both existence and cure of alleged chemical imbalances.

What does the science show? For depression (pp. 71-75 in Whittaker*):

• Studies in 1969 and 1971 revealed no significant difference between serotonin levels of normal and depressed subjects.
• In 1974, serotonin levels were normal for unmedicated depressives.
• Similar results were found repeatedly in subsequent years, leading to this statement (in PLoS Medicine, 2005) by Stanford psychiatrist David Burns: “I spent the first  several years of my career doing full-time research on brain serotonin metabolism, but I never saw any convincing evidence that any psychiatric disorder, including depression, results from a deficiency of brain serotonin.”
• And this pointed conclusion by psychiatrist David Healy (in a PLoS Medicine news release, 2005): “The serotonin theory of depression is comparable to the masturbatory theory of insanity.”

A comparable pattern occurred in the studies of schizophrenia (pp. 75-79):

• No difference between normal and schizophrenic dopamine levels (1974) and no abnormal level of dopamine in unmedicated schizophrenics (1982).
• Similar results were found repeatedly in subsequent years, leading Steve Hyman, neuroscientist, former National Institute of Mental Health director and former provost of Harvard University, to conclude: “There is no compelling evidence that a lesion in the dopamine system is a primary cause of schizophrenia” (in Molecular Neuropharmacology, 2002).
• And: “The evidence does not support any of the biochemical theories of mental illness.” Elliot Valenstein, U. of Michigan neuroscientist, in Blaming the Brain (1998).

How do the psychotropic drugs work? They “create perturbations in neurotransmitter functions.” The brain tries to compensate by doing the opposite of what the drug is striving to do. After a few weeks, the attempts at adaptation break down. The brain becomes “qualitatively as well as quantitatively different from the normal state.” Steve Hyman, American Journal of Psychiatry (1996). The drugs, in other words, make the brain abnormal. [Whittaker, pp. 83-84]

The drugs also worsen long-term outcomes. In schizophrenics relapse rates of psychosis increase when neuroleptics are stopped. When on the drug, the brain becomes supersensitive to dopamine, furiously trying to produce more. Upon sudden drug withdrawal, out-of-control, rapid firing of dopaminergic neurons in both the basal ganglia and limbic areas of the brain produce tics, agitation (sometimes leading to thoughts of violence or suicide), and psychotic relapse. The drug then must be brought back. Continued long-term use, however, at some point makes the wild firing of neurons irreversible. Tardive dyskinesia, frontal lobe shrinkage, and permanent psychosis result. (Guy Chouinard, physician, McGill University, in various psychiatric journals 1978-1991). [Whittaker, pp. 105-07]

Whittaker does not stop at depression and schizophrenia. He meticulously documents similarly flawed science and destructive outcomes of drugs for anxiety (the benzodiazepines, such as Valium and Xanax), bipolar disorder (Lithium), and so-called ADHD (Ritalin and its relatives).

Evidence for psychosocial causes of mental illness and the effectiveness of psychosocial treatment?

• World Health Organization cross-cultural studies in 1969, 1978, 1997 have shown that medicated schizophrenic patients in the US and five other developed countries fared much more poorly—short term and long term—than the mostly unmedicated patients in India, Nigeria, and Columbia. [Whittaker, pp. 110-11]
• In the pre-drug era, the majority of first episode schizophrenics were dismissed from their hospitals within a year, 50 percent as cured, 30 percent as relieved. Twenty percent or fewer needed continual hospitalization. Today, the recovery rate is 36 percent and patients over a ten-year period require three times as many hospitalizations as their counterparts a century ago. The mentally ill die 15-25 years earlier than normal and their death rate has dramatically increased in the last 15 years. [Whittaker, p. 335]
• In Tornio, Finland (western Lapland), “open-dialogue” family-centered therapy has reduced first-episode schizophrenia by 90% since the 1980s. Psychotic symptoms often retreat within a month. Drugs are seldom used; if necessary, they are used in modest dosages and short term. One ward of the hospital is empty because schizophrenia is disappearing from the region! (More here: 1, 2, 3). [Whittaker, pp. 336-44]

Bottom line: the science is not there for biopsychiatry. And the above is merely the tip of Whittaker’s iceberg of evidence.

The science is not there for biopsychiatry, just as it is not there for low fat diets. But nor is it there for zero-rate interest and “quantitative easing” in economics as cure of our current Great Recession. What bothers me in particular about psychiatry is the immediate and concrete self-evidence that the drugs cause harm, such as flattened affect, subdued behavior, and the appearance in patients of looking and acting drugged.

One can argue that economic thinking is abstract and the chains of reasoning long. Therefore, failure to understand its arguments may be excused (despite the harm caused by the boom/bust cycle of the 2000’s). But psychiatry, where the effects of the practitioners’ actions are immediately evident? Where the effects of a legal drug show little difference from the effects of an illegal one? That I do not understand.

Whittaker has performed profound service to science by writing Anatomy of an Epidemic. As with the work of Gary Taubes, I urge you to read Robert Whittaker for the science he has uncovered, for the meticulousness of his method, that is, for his epistemology, and for his courage to expose a profession that refuses to examine itself.




*Page references are to Whittaker. Full journal citations are in Whittaker’s notes. For a concise, bullet-point presentation of source documents in both of Whittaker’s books, see this web page.

Nutrition and the Argument from Uncertainty

The fallacy of the argument from uncertainty, or at least one form of it, might also be called the “it’s better to be safe than sorry” argument. For example, the European Union among other inanities recently ruled that children under eight must be supervised while blowing up a balloon, lest the children swallow or choke on part or all of the dangerous inflatable. How likely is this to occur? “Well, we don’t really know for sure,” the reasoning apparently goes. “We can’t be certain, so it’s better to be safe than sorry. An adult must be present.”

The problem with this reasoning is that it is asking opponents to prove a negative. “The balloon might cause choking. Prove that it won’t.” In logic proving a negative cannot be done; the burden of proof is on the one who makes the positive assertion. All that can be said accurately here is that the probability of choking is minuscule and parents must choose their own levels of risk tolerance. When pressure groups and their legislators tell us what to do, our freedoms and possibly our health become endangered.

This last is meticulously demonstrated in the exhaustive investigations of science writer Gary Taubes. In his two latest books, Good Calories, Bad Calories and Why We Get Fat, Taubes reviews over one hundred years of research on the causes of several diseases of civilization, especially heart disease, obesity, and diabetes. His finding is that not only is the consensus of the past thirty to forty years wrong, but that it also was generated and is today still maintained by the argument from uncertainty (my terminology, not his).

The litany of contemporary nutrition says that we should eat a high carbohydrate, low fat—low saturated fat—diet in order to maintain our heart health, remain trim, and fend off diabetes. If overweight, we should of course exercise and cut back on the calories. Taubes found little sound evidence in the scientific literature to support these claims and indeed uncovered a wisdom that was conventional for over a hundred years, until after World War II, that said good health, including trim weight, is achieved by eating a low carbohydrate, high meat, fish, and fowl diet. That is, cut out the sugars and starches and eat as much of the rest as you want. Exercise? It makes us hungry, something from the foggy distant past that our mothers and grandmothers used to say; it does not cause weight loss. Cholesterol and saturated fat? No causal relation to heart disease. Go low carb for all three diseases.

What gives? Are today’s nutritionists lying? No, just “better to be safe than sorry,” so they seem to be saying. During the 1950s and ‘60s, the more rigorous scientific researchers said that data on fat and cholesterol in relation to heart disease were inconclusive, in particular the data of the Seven Countries Study, a project notably omitting France and other countries that would have contradicted the study’s findings. This study, the rigorous researchers said, was at most associational, not causal.

The promoters of the Seven Countries Study, however, said that lives were at stake. We can’t wait for “final scientific proof” (Taubes, p. 23). We must inform the public and have them change their diets. This attitude partnered with the ‘60s hostility to McDonalds and other high-fat fast food diets and culminated in the McGovern report of 1977 that made the litany virtually gospel. In the meantime, well-controlled experiments, right up to the present, continued and still continue to disconfirm the creed. Selection bias, the omission of anomalous data, is a term Taubes uses to help explain the championing of the litany.

In the course of his investigations, Taubes most importantly has liberated obese people from the tyranny of the “gluttony and sloth” argument. “You’re overweight because you eat too much and exercise too little.” Implication? Weakness of the will, bad character. Taubes and the more rigorous researchers? Clearly there is a genetic component to growing wide, just as there is a genetic component to growing tall. Causation indeed likely runs in the opposite direction. That is, we are not necessarily fat because we overeat and underexercise. Rather, we eat more because we are growing and become sedentary because we are fat.

The mechanism of obesity, writes Taubes (pp. 118-21), operates through the hormone insulin. The more carbohydrates we eat, the more insulin our bodies secrete, the more fat—for obese people, at any rate—is taken out of our bloodstream and stored in our fat cells. “Insulin,” as Taubes puts it, “works to make us fatter.”

Coercion in the public schools to make children eat “right” or less has become common, just as the European Union is now making sure children are not unduly exposed to those allegedly dangerous inflatables. Aside from the issue that governments have no right to tell us what or how much to eat, or how we should micromanage our children, how fallacy-proof is the scientific evidence that has led to these policies and near dogma about health and safety? How long before we’re all compelled to eat “right” or less?

Taubes has shown us how bad science can become a new consensus and lead to policy. I hope my attempt to condense his seven hundred pages into a few paragraphs is clear and correct. Why We Get Fat is only two hundred pages. I enthusiastically recommend that you read it. Taubes’ writing is sparklingly clear. His website is garytaubes.com.

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This now completes five years of blogging. January 2012 begins the next five. Here are a couple of follow-ups on previous posts.

On Hitting . . .  Dogs and Children. “With the popularity of The Dog Whisperer television show, books and products, the controversy over which methods are the most humane and effective ways to address behavior problems in dogs is dividing dog lovers all over the world.

“While animal behaviorists, trainers and other dog professionals recognize that the show is exposing dog owners to the possibility that their dogs’ behavior can be changed (and indeed, business is booming), the concern is that the show gives the false impression that behavior can be changed within a matter of hours and that the methods used are known to incite or increase aggressive behaviors.” Read more (1, 2).

Should Spanking Be a Felony? “Is it right or wrong to spank? It is not a question of right or wrong; in a way it is a case of cowardliness, for you are hitting someone not your own size. I don’t suppose you hit your husband when he is being a nuisance. Is it because you wouldn’t dare? He might strike you back. Of course, you’re perfectly safe hitting your child of three. She can’t strike you back.

“Spanking is an outlet for adult rage and frustration and hate. . . . Happy mothers do not spank . . .”

--A. S. Neill (pp. 99-100), Freedom—Not License!