Medscape Psychiatry’s deep plunge into the woo

How exactly do researchers know if a mouse is depressed?

Don’tcha know? They stop eating their cheese.

  • Medscape Psychiatry is a major source of medical misinformation.
  • Medscape Psychiatry offers free continuing education credit to physicians willing to suffer through its terrible content and site and provide answers to unanswerably bad questions.
  • Medscape Psychiatry promotes quack, unproven, and not-yet proven medicine.
  • If physicians depend on Medscape Psychiatry for their information, they will be ill-prepared to deal with patients who come confused by trash claims that they have encountered on the Internet.

woo meeterI once liked Medscape, although when I was invited to submit a review of screening for depression to it a number of years ago, I declined. I was being offered thousands of dollars ($5,000 if my memory is correct) to contribute an article. The editors were requesting a high quality review and would free offer continuing medical education credit for physicians completing a test after reading my article. All well and good, except the money would come from Pharma. Although no one would have any say in what I wrote, I declined. I did not like the appearance of a conflict of interest.

Wikipedia describes Medscape:

Medscape is a web resource for physicians and health professionals. It features peer-reviewed original medical journal articles, CME (Continuing Medical Education), a customized version of the National Library of Medicine‘s MEDLINE database, daily medical news, major conference coverage, and drug information—including a drug database (Medscape Drug Reference, or MDR) and drug interaction checker. All content in Medscape is available free of charge for professionals and consumers alike, but registration is required.

This sounds like a great resource.

Medscape’s Editor-in-Chief is a cardiologist and professor of genomics.  Eric J. Topol, MD. He is world class. I respect his activism for less-is-more-medicine, Choose Wisely. I recommend his book, The Patient Will See You Now: The Future of Medicine is in Your Hands.

medscape recommendations

For readers who just can’t get enough misinformation on their own, Medscape Psychiatry provides some recommendations.

I have not forgotten when at University of Michigan Medical Center, he protected my venture into studying how couples cope with a myocardial infarction. The Michigan Heart Project would eventually become a multimillion NHLBI funded project, but I had $6,000 in foundation funding at the time. I drew impolite snickers when I presented at the elite Division of Cardiology morning rounds. Dr. Topol came forward and said he did not understand marital dynamics, but what I was doing fit with his clinical experience. He ensured that I had access to patients, but asked nothing in return.

The Google review of Eric Topel book starts:

A trip to the doctor is almost a guarantee of misery. You’ll make an appointment months in advance. You’ll probably wait for several hours until you hear “the doctor will see you now”—but only for fifteen minutes! Then you’ll wait even longer for lab tests, the results of which you’ll likely never see, unless they indicate further (and more invasive) tests, most of which will probably prove unnecessary (much like physicals themselves). And your bill will be astronomical…

And gets better after that [applause].

But I am writing this post because I am fed up with Medscape Psychiatry. I am writing to request imposing martial law and intervening into an unruly and poorly managed intellectual, medical, and scientific slum.

For too long, I have been annoyed and then alarmed what I have seen posted on a regular basis at Medscape Psychiatry.

Some editorial oversight of Medscape Psychiatry should be established. Its granting of continuing education credit for current content should be suspended.

I wonder what the correct incorrect answer is.

 Intelligent readers of Medscape Psychiatry will repeatedly have to ask themselves that question when taking a continuing education assessment.

I’m sure some of the readers of Medscape Psychiatry go to the website looking for cheap and easy continued education credit. But I think some are there to learn about recent advances in psychiatry. Some of them to learn how to critically appraise the junk that is being fed them, not only in the media, but in JAMA Psychiatry, like  what I critiqued in Too much ado about church attendance and suicide rates among women.

MartialLawNowInEffectSigns2013O_zpscb21d53aWould someone please fix the very broken Medscape Psychiatry or put it out of its misery?

A sampling of recent content from Medscape Psychiatry.

When Psychiatry’s Cures Were Worse Than the Illness Stéphanie Lavaud; Patrick Lemoine, MD, PhD

The article starts with a take-it-or-leave-it warning to readers to move on:

How did psychiatry become complicit in Nazi and communist dictatorships? How was it once thought that malaria could cure psychosis? How could the “insane” have been used as scapegoats to such an extent—and, quite often, with the complicity of psychiatrists? If psychiatry has a bad image, it must be admitted that in the past, it applied remedies that were much worse than the disease itself, some of which are still in use today around the globe.

And then the roller coaster goes hurling down:

Medscape: In the history of crazy ideas in psychiatry, which one would you rank as number 1?

Dr Lemoine: One of the most startling ideas was shock theory, which was the belief that because one shock could lead to insanity, another could lead to healing. This theory was not completely wrong if you think about posttraumatic stress syndrome (PTSS). Francine Shapiro, a San Francisco nurse who was bluntly told that she had cancer, thereafter came up with an original method, EMDR (eye movement desensitization reprocessing). Using a technique similar to hypnosis, EMDR consists of having the patient relive, in the flesh, the trauma responsible for his or her clinical presentation of PTSS. Although EMDR is sometimes difficult to endure, the technique is remarkably effective.

Whiskey foxtrot tango! Something is seriously scrambled here.

Common Antibiotic May Treat, Prevent PTSD Megan Brooks

The antibiotic doxycycline (multiple brands) appears to block the formation of negative thoughts and fear memories, which may be help in the prevention and/or treatment of posttraumatic stress disorder (PTSD), new research suggests.

In experiments with healthy adults, those who received doxycycline had significantly lower fear response to fearful stimuli than those given placebo.

“We have demonstrated a proof-of-principle for an entirely new treatment strategy for PTSD,” Dominik Bach, MD, PhD, of the Division of Clinical Psychiatry Research, University of Zurich, Switzerland, said in a news release.

The theory is based on accumulating evidence indicating that extracellular matrix enzymes play a role in memory formation. Doxycycline is a potent inhibitor of metalloproteinase-9 and other metalloproteinases.

Whiskey Foxtrot Tango! If anybody bothers to check, these claims are based on a very preliminary underpowered study with normal controls.

New Community-Based Tools Set to Curb Rising Suicide Rates

The Centers for Disease Control and Prevention (CDC) and several suicide prevention organizations have a goal of reducing suicide by 20% by 2025. They have released several new toolkits to assist communities and clinicians to meet this goal.

The new guidebooks are built on a program developed to help prevent suicide in the healthcare setting, Zero Suicide. They are different because they are tailored specifically for the community setting, said Jerry Reed, PhD, director of the Suicide Prevention Resource Center, which is supported by the Substance Abuse and Mental Health Services Administration.

“Theoretically, what we do in the community should link to what’s being done in the clinical setting,” said Dr Reed during a webinar explaining the new tools. He said if an individual who is identified through community tools as being at risk needs a clinical intervention, he or she “would go through the door of a setting that is prepared to deliver that suicide safer care, and at the end of the process is well on the way to recovery, with their challenge being addressed effectively and efficiently by a well-prepared healthcare system,” he said.

“But it started at the community that was equally as well prepared,” said Dr Reed.

I will not bore readers with a recount of my demolition of the nonsense claims about zero suicide that came out of the Henry Ford Health System in Detroit. But if you missed them, you can find my comments here

generating bs

This is better BS generated with this tool http://sebpearce.com/blog/bullshit/

The Curative Potential of Trancelike Brain States Patrick Lemoine, MD

There’s another altered state of consciousness that I think is important: rapid eye movement (REM) sleep or dreaming. Once again, we use this to gather information. For example, when I do a crossword puzzle and have gone as far as I can with it, I go to sleep. The next morning, I complete the puzzle like magic. Somewhere, in my private library, I’ve gotten the solutions to the unsolved clues.

If we accept the fact that trances, meditation, and REM sleep are altered states of consciousness, we can try to better interpret, understand, or even use dissociations.

Treatment

Such techniques as medical hypnosis and eye movement desensitization and reprocessing (EMDR)—the standard treatment[1] for this type of posttraumatic stress disorder—can be very effective. EMDR involves sending a message, an oversized attachment, via the “cerebral Internet” from the overly emotional networks to the more rational ones in order to archive the trauma.

With the attachment being too large, what do we do in EMDR? We divide it into small pieces, and it ends up going through. And we see, as do individuals who experience these posttraumatic stress disorders and exhibit these dissociative states, that little by little, they manage to control it and possibly transfer their dissociations into their dreams. And that’s it. Some of these individuals even manage to embrace and appreciate their ability to gather information.

Whiskey Foxtrot Tango! The author should be arrested for indecent exposure if he shows his “too large” attachment in public.

Although it is not medically indicated, and I cannot give any information on dosage, I nonetheless recommend that physicians and states allowing medical cannabis complete their CME test on hash brownies or smoking a joint of sativa.

Many of the comments left on this article suggest the readers were indeed stoned. However, others took the article seriously and complained:

Dr. pratibha Reebye|  Psychiatry/Mental Health 11 days ago

It is not evidence based article. There are too many speculations and in clinical practice, such definitive views are problematic.

George Storm|  Other Healthcare Provider 11 days ago

A borderline state and borderline personality disorder are not even slightly related and this article is mostly poorly researched BS.  Ever hear of a peer reviewed article?

David Clayton|  Psychologist 13 days ago

Not all studies show superiority of EMDR. Every dismantling study has shown that taking away the eye movements has no effect on outcome. What is good about EMDR isn’t new and what is new about it isn’t good. Hypnotherapy is much better suited to the treatment of PTSD because of the similarities between hypnotic phenomena and the symptoms  of PTSD, in particular dissociation. Of  distinct advantage in using hypnotherapy is the availability of hypnotic phenomena that can be quickly elicited to protect the patient from becoming overwhelmed with emotional memories leading to treatment failure.

Don Catherall|  Psychologist Apr 6, 2017

I’m sorry but there is too much misinformation in this article to let it stand.

Number one, dissociative states are not “merely extreme flashbacks” in which the subject is trying to find a solution to his/her problem. That is this author’s interpretation and perhaps there are times when it applies, but this interpretation of dissociative episodes is not supported by our modern understanding of flashbacks or dissociative states.

Number two, EMDR is not the standard treatment for dissociation. It is a good treatment for trauma memories, especially when they are somatosensory, but it is not a standard treatment for dissociation. Indeed, introducing EMDR must be approached carefully as it can send a dissociative client into deeper dissociative states.

The author may be right about his notion that trancelike brain states can be curative–see Peter Levine’s discussions of immobilization without an accompanying fear response–but these comments about standard treatment and this author’s idiosyncratic meaning of dissociative states can be dangerously misleading. Medscape should put articles like this through a more rigorous review before posting them.

Probiotic in Yogurt May Improve Depressive Symptoms Probiotic in Yogurt May Improve Depressive Symptoms  Nancy A. Melville

In a recognized preclinical model of depression, investigators examined the gut microbiome of mice before and after they were exposed to chronic stress. The major change they found was a loss of Lactobacillus and an increase in circulating levels of kynurenine metabolites, which are known to drive depression. With the loss of Lactobacillus came the onset of depressive symptoms. But after supplementation with L reuteri to restore Lactobacillus, kynurenine metabolism normalized, and so did the animals’ behavior.

“A single strain of Lactobacillus is able to influence mood,” lead investigator Alban Gaultier, PhD, of the University of Virginia School of Medicine, Charlottesville, said in a release.

“This is the most consistent change we’ve seen across different experiments and different settings we call microbiome profiles. This is a consistent change. We see Lactobacillus levels correlate directly with the behavior of these mice,” said study researcher Ioana Marin, a PhD student.

The big hope for this kind of research is that we won’t need to bother with complex drugs and side effects when we can just play with the microbiome. It would be magical just to change your diet, to change the bacteria you take, and fix your health ― and your mood,” he said.

Although Dr Gaultier knew of no other studies suggesting that symptoms of stress or depression could be improved with Lactobacillus, studies in humans have suggested benefits with other probiotics.

It would be entirely consistent with the content and tone of this article if a psychiatrist recommended a fecal transplant for major depression and schizophrenia.

What is the basis for this crap recommendation? Another Medscape article:

As reported by Medscape Medical News, a small pilot study of healthy men suggested benefits with a probiotic strain of Bifidobacterium longum. In preclinical studies, B longum was shown to be a “putative psychobiotic” that yielded benefits in stress-related behaviors in mice.

Love those readers comments, keep them coming:

Dr. Mark Reyer|  Radiology Mar 16, 2017

How exactly do the researchers know if a mouse is depressed?

Dr. Jan Ferris|  Psychologist Mar 16, 2017

Lol! Don’tcha know? They stop eating their cheese.
@Dr. Mark Reyer The last time I gave the Beck Depression Inventory to a mouse it showed ……

Music and Meditation May Slow Cognitive Decline Fran Lowry

Hopefully my readers have picked up enough critical appraisal skills from my blog posts to handle this one on their own.

Practicing simple meditation or listening to music may help reverse early memory loss in adults with subjective cognitive decline (SCD), according to the results of a pilot study.

SCD, in which people feel that their memory is becoming impaired, may be a harbinger of Alzheimer’s disease, the researchers, led by Kim E. Innes, PhD, from West Virginia University, Morgantown, write an article published online January 18 in the Journal of Alzheimer’s Disease.

“The early intervention period is really important because there is less burden of neurodegenerative changes. Meditation or listening to music are cost-effective, easy for people to do, noninvasive, and have no side effects, and yet they are nonstigmatizing interventions for improving memory, cognition, as well as stress, mood, sleep, and quality of life,” Dr Innes told Medscape Medical News.

Dr Innes and her group randomly assigned 60 adults to take part in either a Kirtan Kriya meditation program or a music listening program.

All of the participants had SCD. Their ages ranged from 50 to 84 years (mean, 61 years). Most were women (85%) and non-Hispanic white (93%).

The study participants were trained to perform Kirtan Kriya meditation. Both groups were instructed to practice 12 minutes a day for 3 months and to then practice at their discretion for the following 3 months.

At baseline, 3 months, and 6 months, the researchers measured memory and cognitive function using the Memory Functioning Questionnaire (MFQ), the Trail Making Test (TMT-A/B), and the Digit Symbol Substitution Test (DSST).

At 3 months, both groups showed marked and significant improvements in memory and cognitive performance (MFQ, DSST, TMT-A/B, P ≤ .04) relative to baseline.

These gains were maintained or improved at 6 months (for all, P ≤ .006), Dr Innes said.

Ketamine for Depression: Key Efficacy, Safety Questions Remain Megan Brooks

At least a bit of sanity and sobriety was introduced in an otherwise carried-away article on ketamine.

Ketamine and other glutamate-modulating agents may represent the first major advance in treating major depressive disorder (MDD) in years, but key questions remain regarding safety, tolerability, and efficacy, experts say.

“The ongoing clinical trial research focusing on the glutamate system may lead to a completely new class of antidepressants that may significantly change the way patients with depression, and in particular, treatment-resistant depression, are treated,” ketamine researcher James W. Murrough, MD, director of the mood and anxiety disorders program at Icahn School of Medicine at Mount Sinai in New York City, noted in a statement.

Regarding clinician practice, “there are many unanswered questions, and both clinicians and patients should remember that ketamine is not approved for the treatment of depression, and large-scale clinical trials in patients have not been completed,” Dr Murrough told Medscape Medical News.

“Therefore, we do not know the optimal way to dose ketamine, how long it should be given, or if it is safe to give over longer periods, for example, months or years. Ketamine can work quickly, but depression tends to be a chronic condition,” he explained. “Therefore, after a patient responds to a short course of ketamine, there is a lack of data to guide next-step decision making in the patient’s treatment.”

I blog at a number of sites, PLOS Mind the Brain, Quick Thoughts, and occasionally, Science-based Medicine. To receive alerts about all my blog posts, just sign up at CoyneoftheRealm.com. You’ll get advance notice of forthcoming e-books and science writing courses as well.