Dear Larry:Many thanks for

Dear Larry:

Many thanks for your comment. I agree that credibility is in question. I don't think the solution is simply to believe or disbelieve the research, or any particular researcher, but rather to critique that research, using understanding of scientific methods. Now I appreciate and agree that we as academics have not done a good and honest enough job of engaging in that kind of objective scientific critique. That is a profound responsibility that we need to take up. I also think, though, that every individual practitioner has a responsibility to read and understand science. It is not enough to read the abstract and conclusions, and then either believe or disbelieve based on pharmaceutical industry funding or the reputation of the researcher. The methods sections needs to be understood and analyzed. Obviously, the msot complex studies will be challenging, but most of this research is rather straightforward, and with one-tenth of the effort we spent learning histology in medical school, the average clinician can understand it. I am working on a book right now to try to translate this level of statistical knowledge to clinicians.

I also agree that Big Pharma has the marketing advantage. But I don't think that the best response to the one-sided and biased advertisements of the pharmaceutical industry is to publish a slew of one-sided and biased anti-pharmaceutical industry books. Neither are credible.

To me, the crux of much of this gets to how we understand science. Science is not about adversarial viewpoints that compete with each other, and in fact glory in such confrontation - as, say, in the law, or in the political theory of democracy (countervailing forces). In science, we actually believe there is a truth, and we need to find and speak the truth. This is not the same, by the way, as being "balanced", a phrase commonly used in our current debates about conflict of interest; one cannot be "balanced" about the truth: the truth is the truth. If I show in my research that lithium level of 5.0 will kill patients, it is not anyone's responsibility, nor at all appropriate, for others to try to do research that shows that a lithium level of 5.0 is safe. Unfortunately, much of our thinking about such matters is suffused with a cultural postmodernsim, with deeply held assumptions about the relativity of truth. (Daniel Dennett's lecture on Postmodernism and Truth is a good source on this: http://ase.tufts.edu/cogstud/papers/postmod.tru.htm).

Part of what I am doing in my book, and in my critique of the biopsychosocial model, is to show how harmful such blithe eclecticism is to our field; where anything goes, we all end up either confused, or believing that there is no truth to the matter. And then it is easy for those with the finances and a special interest (whether the pharmaceutical industry, or managed care, or others) to influence the profession unduly.

I'll plan other posts to spell these ideas out more. But in all this, I agree with your general point, though, that our profession has lost credibility due to our relations with industry.