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The Only Thing That Will Improve Mental Illness Treatment Is Science

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In discussing the complaints made by a group of physicians against Dr. Oz, Dr. David Gorski uses the term "medical quackademia" to describe the collaboration between alternative medicine and evidence-based medicine.

Gorski is a surgical oncologist, and associate professor at Wayne State University in Detroit and chair of the Board of the Society for Science-Based Medicine, a group dedicated to promoting good science in medicine and opposing pseudoscience. He uses Dr. Oz's medical school, Columbia, and its integrative medical therapies program for children with cancer as an example of this medical quackademia. That program uses treatments like:

herbal and nutritional counseling and guidance, aromatherapy (quackery), acupuncture and acupressure (quackery), massage therapy and reflexology (super duper quackery), reiki (rivalling homeopathy for the title of "The One Quackery To Rule Them All"), meditation, exercise, yoga and movement therapy, and a chef program.

Sadly, a similar problem exists, in my opinion, at the Centre for Addiction and Mental Health (CAMH) in Toronto. CAMH does do some groundbreaking original research in neuroscience. A recent study found that people with a severe form of schizophrenia have major differences in their brain networks compared to others with schizophrenia, bipolar disorder and healthy individuals. That was published in the Journal of the American Medical Association Psychiatry.

In another study, they discovered a promising new approach to treat multiple sclerosis. They identified a previously unknown change in the spinal cord related to MS, and a way to alter this change to reduce the nerve cell damage and alleviate motor problems that occur with the disease.

This is impressive work and what we should expect from them as it is research that will help develop new and more effective treatments.

But then, they also promote the usual soft "alternative science" approach as exemplified by a recent blog on Taking Back Experimentation by Josina Vink whose credentials are not given. Ms. Vink argues that mental health systems in Canada have a dark history with experimentation and cites such treatment modalities as hydrotherapy, insulin coma, and the medical surgery of lobotomy. She says that "Because of the legacy of these tests and studies, there is some resistance to experimentation in the context of mental health today." She wants to partner "with people with lived experience to co-design, try out, and refine new ways of working."

What she refers to as tests and experiments were actually treatments used by doctors in a desperate attempt to help those poor people who were trapped in their severe illnesses and housed in asylums because they were incapable of existing in society. The docs weren't necessarily cruel but desperate to try something that might work. And these treatments were not unique to Canada but were used internationally. Modern lobotomy (leucotomy) was developed by the Portuguese neurologist, Egas Moniz, in 1935. He was awarded the Nobel Prize in the category called "physiology or medicine" in 1949.

What Ms. Vink leaves out is the fact that science went on to discover drugs for psychosis, depression and mood disorders and that these were not developed by those with lived experience but by scientists. Of course, these drugs do have side effects (as do all drugs) and they only target the symptoms rather than the cause (as is the case with many illnesses) but science is working to find the cause and better treatments.

What Ms. Vink said about mental illnesses, she could also have said about other areas of medicine. For example, blood letting was a common practice at one time not because doctors were torturers but because they were desperately trying to help. One blood-letter, Dr. Benjamin Rush, signed the U.S. Declaration of Independence and has a medical school named after him in Illinois. Blood letting was not replaced by strategies developed by the ill -- those with lived experience -- but by science.

An interesting analogy is that of migraines. Treatment for that condition was originally punching a hole in the head to let the pain and the spirits out. That was followed by applying a hot iron to the head, blood letting and inserting a clove of garlic through a slit in the temple. In the 1940s, the ergotamine class of drugs began to be used for migraines and while they were somewhat effective, they had some very nasty side effects.

Fortunately, in the early 1990s, scientists and not migraine sufferers introduced a new class of drugs called the triptans which have turned out to be very effective with minimal side effects.

Science may not be as well advanced in the treatment of the most serious of mental illnesses as they are in other areas but, hopefully, we will get there sooner than later. But that goal will be achieved by scientists some of whom work at CAMH and not by those suggesting we convene a group of people with lived experience to solve these puzzles.

More might be accomplished if we transferred the money for these soft "sciences" into real science while respecting the perspective of the ill and their families in treatment. This is an already common practice known as patient-centered care.

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