I'm not sure the psychologists are mad at you for highlighting the report itself, and I'm sad to see you may have missed the point. Every profession comes under scrutiny, and the best professionals understand that such scrutiny is often the impetus for change in the right direction. Discussing the report without trying to see things from another perspective, however, was the real disappointment. The simple fact I would ask you to consider is that there may be more to practicing psychology than following the numbers. There is a balance in psychology - psychologists practice scientifically sound methods, as written in our ethics codes and as we are taught in school, while engaging genuinely and empathically in human interactions, and the recovery that often results is the very reason our field continues to grow. The myriad of variables that go into human suffering in all its forms simply cannot be quantified, but psychologists, including Psy.D.s, (who by the way must undergo rigorous training if their programs are APA accredited, and can be licensed to practice independently in every state,) have the challenge of employing scientific approaches that are the result of decades of evolution in behavioral science to bring structure to every treatment in order to maximize its benefits for each individual. The endowment of knowledge available to us is not limited to empirically based practices, however. No therapy, empirically supported or not, includes a script or formula that regiments treatment so tightly that success can be guaranteed; I can assure you that anyone genuinely invested in the "helping" part of the helping professions would use that method alone if such a treatment existed, but the human element makes such an intervention impossible. A good professional, whether psychologist or physician, Ph.D. or Psy.D., M.D. or D.O., uses the extent of her or his knowledge to provide whatever treatment works best for the patient, with as much science, evidence, and safety built in as is available in the data we're trained to comprehend. Sometimes the patient fits right in with the data sets for the empirically proven methods, and sometimes they don't. When someone is sick and needs help, no matter what kind of sick, what works for ???most??? becomes irrelevant if it doesn't work for THEM. There are empirically supported methods and methods with only anecdotal efficacy, but when we are in pain, results are results. Psychologists are professionals, and the best professionals use every tool in their kit to work WITH patients and find just the right balance that leads to the best possible outcome. It was a shame that your article on psychology did not demonstrate the same level of education, and failed to exercise or encourage the same open-mindedness.
Sharon Begley
Some Treatments Just Don’t Work
But doctors use them anyway. The case for evidence-based medicine.
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In for a dime, in for a dollar, my father always said—so since I already have what seems like every psychologist in the country furious at me for writing about a report that takes the profession to task for practicing forms of therapy that have no scientific support, and half the doctors annoyed at me for noting the disconnect between what treatments they offer and which ones are supported by solid empirical evidence, I'll wade into these treacherous waters yet again. By "treacherous waters," I mean evidence-based medicine (EBM): choosing treatments based on the clinical evidence that they work. (Click here to follow Sharon Begley)
This, of course, has become a huge theme in the current health-care debate, since rejecting treatments without such support, and sticking to those shown to work, promises to reduce the country's health-care bill. Of course, practicing medicine should not be like following a cookbook recipe. If doctors conclude that an individual patient is very different from those in studies that showed a particular treatment to work, they might be justified in treating that patient with something other than the EBM-supported drug or procedure. The trouble is that too many doctors think they have exceptional patients.
My thoughts have turned to EBM again because the Cochrane Collaboration, an international consortium that evaluates medical research, has released its latest reviews. Scanning them, you can't help but despair at how many ineffective, useless treatments patients get. Just to be clear, that's not intentional: the realization that something doesn't work, or that it doesn't work as well as something else, comes slowly, only after years of research on thousands of patients. But that's why we need more of this, fast—and why it got $1 billion in the federal stimulus bill last winter.
You can find all the latest Cochrane evaluations of various treatments here, but let me mention some of the more interesting:
* Opioid drugs for hip and knee pain caused by osteoarthritis? Bad idea. "We found that pain reduction with opioid treatment was small to moderate. Increasing the dosage did not appear to result in further pain reduction," said Eveline Nüesch, a research fellow at the University of Bern in Switzerland, who led the Cochrane review on this. "However, patients taking opioids have large increases in risks of experiencing adverse effects," such as nausea and constipation. Added Nortin Hadler, professor of medicine at the University of North Carolina at Chapel Hill and spokesperson for the American College of Rheumatology, "It is striking how little additional benefit patients with hip or knee pain can expect from taking opiates compared to placebo." Pain, of course, is among the conditions most susceptible to a placebo effect. The thumbs-down on opioids is based on 10 studies comprising 2,268 patients.
Question: will doctors stop prescribing opioids to most of their osteoarthritis patients? Will patients, believing in the power of these drugs, sit still for plain old acetaminophen, which Hadler calls "as good as it gets"? (Similarly, despite 20 years of research on electrostimulation for osteoarthritis of the knee, it's not clear that it reduces pain or physical disability.) It would be interesting to see the annual bill for the pointless use of opioids.
* On bulimia (which affects about 1 percent of women) and binge eating disorders (2 to 5 percent), the verdict is more optimistic: psychological treatment can help a lot, and cognitive behavioral therapy (CBT) is the most effective talk therapy. That's based on 48 studies with 3,054 participants. CBT (typically, 15 to 20 sessions over five months) helps patients understand their patterns of binge eating and purging, recognize and anticipate the triggers for it, and summon the strength to resist them; it stops bingeing in just over one third of patients. Interpersonal therapy produced comparable results, but took months longer; other therapies helped no more than 22 percent of patients. If you or someone you love seeks treatment for bulimia, and is offered something other than CBT first, it's not unreasonable to ask why. Cynthia Bulik, director of the University of North Carolina Eating Disorders Program, summarized it this way: "Bulimia nervosa is treatable; some treatment is better than no treatment; CBT is associated with the best outcome."
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