Seth's Blog

Daniel Carlat, a Massachusetts psychiatrist, is the author of the excellent blog The Carlat Psychiatry Blog. He also wrote an excellent article in the New York Times Magazine about working on the side as a drug rep: He told other psychiatrists about new drugs. He quit (or was fired) because telling the truth wasn’t compatible with the job.

Unhinged, his new book (sent to me by the publisher after I asked for it twice — that’s how much I wanted to read it), covers the same ground. Its subtitle (or two subtitles) is/are The Trouble With Psychiatry — A Doctor’s Revelations about a Profession in Crisis. The contents were well-written, but none of it was new to me: the “chemical imbalance” theory of depression is a convenient myth, how drug reps work, how drug companies influence doctors, diagnosis difficulties, the cases of Charles Nemeroff and the like. (I did learn that Nemeroff was called “the boss of bosses” because of his prominence and power.) If any of his criticisms are new to you, this book is a great introduction. He uses many stories of patients to make his points.

Overall, I found the book too calm. What Nemeroff and others like him did I find outrageous but Carlat doesn’t sound outraged. Maybe he is, I have no idea, but his book is more reasonable-sounding than scornful and I would have preferred scornful. At one point he says he wrote an “angry” op-ed for the New York Times about something and I thought: good, some emotion! 

The crisis of the subtitle (“A profession in crisis”) is enticing but is not borne out by the contents. Carlat dislikes aspects X, Y, and Z of his profession, but one person’s dissatisfaction does not equal crisis. I saw no signs he is part of a growing movement. My take on the trouble with psychiatry is that psychiatrists don’t understand what is wrong in almost every case they see and, due to lack of understanding, do a poor job of fixing the problem. Lack of understanding by doctors is nothing new and, until someone has a better understanding, doesn’t pose a professional problem. This basic truth goes unmentioned in Unhinged.

• A Chinese medicine huckster. “Zhang asserts that different body organs have their own color preferences: lungs like white food, the liver likes green food, kidneys like black food, the heart likes red food and the spleen likes yellow food.”
• According to Gawker, “kombucha tastes terrible”. Some store-bought kombuchas contain too much alcohol.

Describing my first day of teaching at Tsinghua, I wrote:

The students did brief introductions. Many students appeared to think that one student’s Chinese name was humorous. This was briefly explained to me but I still have trouble believing it.

I don’t remember the brief explanation. At the time I didn’t know that my Chinese name sounds exactly like the word for eggplant, which has different characters. As the Tsinghua story suggests, this isn’t rare. I met a girl whose name sounds the same as China’s ruler. (Different characters, of course.) Anyway, it seems a blessing that my name has a humorous side and perhaps that’s what the parents in this case were thinking.

Speaking of good-luck charms, a study at the University of Cologne found in four different experiments with four different tasks that people did better when they believed that they somehow had Lady Luck on their side. For example, they did better when they had their lucky charm with them than when they didn’t.

If lucky charms work then it’s reasonable to buy them. I explained why it’s helpful in an evolutionary (i.e., long-term) sense to buy them: long ago, the resources paid for them supported technological innovation.
Via Bad Science.

In my recent Medical Hypotheses paper, I argue that scientists care a lot about status display and this interferes with good science. Failure to self-experiment is an example. I think the main reason self-experimentation is unpopular is that it looks low-status. Here I explain how sleep researchers would benefit from the self-experimentation they don’t do.

In a May New Yorker article, Janet Malcolm gives another example of status display getting in the way of doing a good job:

Not speaking to their clients [children] is almost a badge of honor among law guardians [lawyers assigned to look after the interests of children in the legal system, such as the child of divorcing parents]. In a 1982 study by the New York State Bar Association, this practice was found to be ubiquitous. . . . Judges continue to turn a blind eye to what the Bar Association called the “phantom” attorney.