Doctors and Psychologists Don’t Hate Science—
They Treat Real Patients:
A Reply to Sharon Begley and Newsweek
Ivan
J. Miller, ©2009
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Sharon Begley is wrong when she compares the medical profession
to “hysterical conservatives” who “seem to hate
science,” as she did in her Newsweek column on May 4, 2009
in “Why Doctors Hate Science.” She is wrong when she
claims that “psychologists reject science” as she
did in her column on October 2, 2009 in “Ignoring the Evidence.”
While she finds a few legitimate examples of problems, she is
pushing a narrow interpretation of science that is not in the
best interest of patients. When it comes to good science, good
treatment, and good use of scientific evidence, medical doctors
and psychologists are a lot closer to the mark than Begley and
the critics she embraces.
In “Doctors Hate Science,” Begley decides that science
shows that hypertension patients should be treated with inexpensive
diuretics rather than medications that have fewer side effects
because both lower blood pressure. Not if you ask the patient
who knows that the diuretic causes frequent urination. Who would
want to pee more than a dozen times a day, wake twice at night
to go to the bathroom, fear getting stuck in a traffic jam without
access to a toilet, avoid long meetings, get fatigued during exercise,
and lose sexual function? There are good reasons that doctors
prescribe more expensive anti-hypertensive medications that have
fewer side effects than diuretics.
Again looking at research and not patients, she finds that the
positive symptoms of schizophrenia (hallucinations) respond as
well to the old generation antipsychotics that cost much less
than the new, and scolds psychiatrists for prescribing the new
generation medications. As a psychologist, I have known over 1,000
patients who had the old generation of medications prescribed,
and I only know a few who did not find the medication awful. As
one patient described it, it made him feel like a block of wood.
The old generation makes emotions flat, and patients who take
them are often unable to experience pleasure. The vast majority
of patients resist or refuse these medications. With the new generation,
people with schizophrenia can more successfully recover much of
their ability to enjoy life, control symptoms, and have relationships.
In other words, in addition to controlling the hallucinations,
with the choice of new generation medications, more people with
schizophrenia can have a life. Real doctors care about a patient’s
quality of life, and not just whether the scientific data suggested
that a specific symptom response was equal.
Now Begley is attacking psychologists by siding with an academic
scientist who says that practicing psychologists don’t follow
academic research closely enough. She complains that practicing
psychologists report that their own experience is more informative
than cookbook programs that are researched in academic and scientific
settings. In the real world of treating patients, psychologists
treat the concerns that patients bring into the office. Most psychologists
have a Ph.D, which requires training to be a scientific researcher,
and are therefore also doctors. Other psychologists have a professional
doctorate degree, which involves the extensive study of scientific
research. Psychologists are dedicated to evaluating the full range
of research. When science has relevant information, it spreads
through practice and is adapted. Research supports a wide range
of approaches, but not all. The research does not just support
the few approaches that Begley likes.
Patients each come in with their own unique and complex problems,
which are not the simplified, single diagnosis, mild problems
that are commonly researched in academic settings. Research does
confirm that the psychologist’s relationship with a real
patient and with the patient’s needs is more important than
allegiance to scientific theory. As a psychologist who makes his
living treating primarily self-pay patients, I know that I must
be effective and responsive to my patients’ needs. I also
operate a referral organization for 78 therapists and am aware
of the kind of therapist that patients find successful. If a therapist
were to offer only scientifically proven, cookbook treatments,
I know that therapist will be out of business. Rigid adherence
to science, as Begley prescribes, does not inform psychologists
as well as personal experience and the eclectic incorporation
of scientific evidence. I do not know of any therapist who is
not influenced by the cognitive behavioral approach that Begley
favors. The eclectic approach often incorporates the research
that Begley promotes, but is not blinded by it. The actual evidence
supports multiple theoretical approaches.
Real evidence-based medicine not only looks at data, but also
uses experience, judgment, and an awareness of patient needs and
individuality. Simplistic comparative effectiveness research,
as Begley and her medical critics prescribe it, would be a tyranny
of bureaucrats. These bureaucrats may also be academics, but they
are usually not in the business of treating real world patients.
While there is great value in pursuing comparative effectiveness
research, if it is properly interpreted, it will not save as much
money as its proponents imagine, and the patient-provider treatment
team will still be able to make their own treatment decisions.
For now, it is a good thing for patients that health care is provided
by doctors and psychologists, and not by Begley’s idea of
science.
Ivan J. Miller, Ph.D. is a psychologist in private practice in
Boulder Colorado. He is President of the Boulder Psychotherapists’
Guild, Inc. and previously served on the American Psychological
Association’s Task Force that created the “Criteria
for Evaluating Treatment Guidelines,” the scientific criteria
recommended for evaluating evidence-based medicine guidelines.
Miller is the author of Balanced Choice: A Common Sense Cure for
the U.S. Health Care Systems. Miller’s proposal would improve
a single payer system, such as Medicare, by adding the responsiveness
and choices of market forces, while eliminating administrative
waste and the abuses of insurance-driven healthcare. www.BalancedChoiceHealthCare.org
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acknowledged.
Begley, Sharon. May 4, 2009. “Why Doctors Hate Science.”
Newsweek.
http://www.newsweek.com/id/187006
Begley, Sharon. October 2, 2009. “Ignoring the Evidence.”
Newsweek.
http://www.newsweek.com/id/216506
Ivan
J. Miller, Ph.D.
Licensed Clinical Psychologist
Flatirons Medical Arts Building
350 Broadway, Suite 210
Boulder, Colorado 80305
(303) 499-3888