Post-truth politics: a new phenomenon? Not in neuropsychiatry!
We have repeatedly addressed the difficult times that we are experiencing in treatment development for brain disorders. Many ECNP initiatives, including our successful New Frontiers Meeting held every year in March in Nice, where academia, industry, regulators, payers, patients, and families come together, try to tackle this increasing threat. There are many reasons why this threat is greater in treatment development for brain disorders than for disorders in other areas of medicine (e.g. oncology, cardiovascular) including the complexity of the brain, the difficulty in identifying homogeneous samples based on its pathophysiology for clinical trials, risk avoidance in times of economical crisis, etc.
What is probably another differential factor from other areas of medicine is the imposed challenge posed by those who work against the advancement of knowledge in our field. And, in that respect, psychiatry leads the pack. I do not believe there is any other area of medicine with more movements (including “internal movements”) working against it. It is clear that psychiatry, including neurology or neuropsychiatry, has historically made many mistakes. But I believe it is also true that there are hidden interests, including commercial ones, in many of these movements. And they all have something in common: they all go against the evidence and scientific method.
We probably do not give enough credit to Sir Karl Raimund Popper, one of the greatest, if not the greatest, modern philosophers of science. Popper took falsifiability as the only criterion between what is and what is not scientific. Only a theory that is falsifiable should be considered scientific. It was clear to Popper that theories such as Marxism or psychoanalysis are not scientific. Core to this principle was the need to test for the null hypothesis to ensure that the truth of a conclusion is irrefutable. On the contrary, attempting to demonstrate a hypothesis on the basis of testing that hypothesis leads us to inductive reasoning, which is prone to the problem of the uniformity of nature assumption described by David Hume. Well, the truth is that we are often surrounded by scientists who try to prove the correctness of their hypotheses rather than apply Popper's falsification theory.
It would not be difficult to identify many figures in our field who, rather than try to prove the null hypothesis wrong, would rather show that their a priori and often prejudiced hypotheses, are right. And there are many ways to achieve that goal in violation of scientific method. Some leaders of those movements may well be making a living by making false statements based on purposely wrong inferences from the evidence available. Many make a good money selling books (of course no conflict of interest is ever disclosed) or giving controversial talks in which they say what they know those attending those talks want to hear. All the very opposite of what science should be! We have recently seen very good examples of how important figures in the anti-neuropsychiatry movement have not only used a non-scientific method but have used the available evidence in the wrong way to attack our field. Even people from respectable institutions such as Cochrane, who have made their living from adulterating the available evidence, pretending that others (but not them) had conflicts of interest, had to be expelled from those institutions.
But in a post-truth and fake-news world, where post-factual theories are rapidly spread though social media, none of this should come as much of a surprise. We are surrounded by people who, heedless of ethics and values, would do whatever it takes to defend their cause. And they are blind and deaf when confronted with facts. This is one of the most serious problems that science, and our field in particular, will need to face in the decades to come. Or need I remind you how many millions of people in the US hold the belief that creationism is the sole and absolute truth, or that vaccines cause autism (as advocated by leaders of the post-truth movement occupying the highest public offices), to name a few.
When I was very young, my father once told me that “los peces comen contra corriente”. In English you might say “It’s the squeaky wheel that gets the grease.” It took me some years to understand the full meaning of what he said. Nowadays with populist movements emerging all over the world, what he said is more timely than ever. And we have many such fish eating against the current in the different groups fighting against the scientific field of psychiatry and the neurosciences. Let us fight back with the scientific method. It is the best weapon we have. So far.