Wednesday, July 13, 2011

Do diff OCD sx differ genetically? Let's ask normal ppl.

Do diff OCD sx differ genetically? Let's ask normal ppl.

A Multivariate Twin Study of Obsessive-Compulsive Symptom Dimensions.
Alessandra C. Iervolino, PhD; Fruhling V. Rijsdijk, PhD; Lynn Cherkas, DPhil; Miquel A. Fullana, PhD; David Mataix-Cols, PhD. Arch Gen Psychiatry. 2011;68(6):637-644. doi:10.1001/archgenpsychiatry.2011.54

This study was recently published. It is a good example to support my idea that we generally should be wary of "findings" published in psychiatry. Apparently, anything goes.

It also is a good example of the leading way to critique any study: evaluate the degree that the hypothesis, what the study is supposed to be about, with what was actually analyzed - how were the different constructs measured, what was the study sample, etc.

I will note a little abt this study just to show how commonplace it is for "findings" to pop up in the literature, and be accepted as knowledge, when the actual evidence is nothing like the supposed finding or knowledge.

Here is the trick: recognize that for every scientific idea, there is the general, global statement being investigated, and then there is the technical specification of that. Kind of like the difference between what a new "law" is supposed to be, and what the legalese sounds like. The health care reform bill says a few things, such as "there will be these state 'exchanges," and "kids can be on their parents' health ins until the age of 25." Now, does it take 1,000 pages to say those things? No. But the law has to be technically specified with all of that stuff about "the party of the first party" and "the party of the second party."

So: Big Picture, and Devilish Details.
We often have these questions about some psychological issue. We go get articles, and try to figure out what evidence there is. Since the technical aspects can be difficult to understand, there is the opportunity for the authors to fudge, or embellish, or interpret beyond the data.
We should always have our skeptical-lens glasses on. We should always ev aluate the degree that the devilish details line up with the big picture - the goal.

Here is an example: these researchers claimed to investigate whether the genetics differ between people with different types of OCD. We know some ppl with OCD do washing, and some do checking. Are there genetic differences?

That is my rephrasing. We can look at theirs (it is not necessarily the case that authors actually tell you the big picture - here, they are not too clear).
From  the abstract, which should hit the essentials clearly and succinctly:
"Context: Obsessive-compulsive disorder (OCD) is clinically heterogeneous, but it is unclear whether this phenotypic heterogeneity reflects distinct, or partially distinct, etiologic mechanisms."
"Objective: To clarify the structure of the genetic and environmental risk factors for the major symptom dimensions of OCD."
(Did you notice the drift? No. Neither did I.)
"Results: A common pathway model did not fit the data well, indicating that no single latent factor can explain the heterogeneity of OCD."
(Of what? Of "OCD.)
"Conclusions: Obsessive-compulsive disorder is unlikely to be an etiologically homogeneous condition."

OK: look back at my paraphrase - very close to their "conclusion:" "OCD is unlikely to be homogenous."
(did you see that drift? Is "unlikely" in there because they found support for the competing hypothesis, and they are just refraining from strong wording so as to be more speculative, as early science should be? Or, are they saying "unlikely," because their study actually has no dirent relevance to this "conclusion"? -If it has no relevance, then why conduct the study and why publish it?
Serioulsy. This is a problem. We are failing to advance our knowledge of psych problems because we are goofing around with non-issues and worthless studies. This gets us nowhere.
How does this stuff get funded and published? We have to look elsewhere, like sociology and anthropology.

OK, MedsVsTherapy, what is your beef?
Here it is: genetic connections were studied between categories of obsessive characteristics and compulsive characterostics in - get this - totally normal ppl.
As far as we can tell, there was NO ONE with OCD in the data set. No one.
How do you study the genetics of OCD when your data set has no one with OCD?

You can't.

Look back: Big Picture, Devilish Details. The big picture is abt OCD types, and the devilish details are abt normal ppl.

Those of us who do not have OCD still recognize OCD traits in ourselves.
If you gave 4,000 of us a questionnaire that asked us how much we like to hoard things, or put things in order, or be scrupulous about washing for fear of germs, some of would score higher on each of these characteristics, and some of us woould score lower.

Then, you could look at our genetic similarities and differences. Do non-clinical OC traits vary by gen similarities and differences? Yes, no, or maybe.
This is what the study did. They looked at many pairs of twins. Not ppl with OCD. Why? Because they were there.

Do they make this clear? Not really. They drift from talking about abnormal to analyzing normal with little fanfare - they move from a Big Picture abt one thing to Devilish Details abt another thing without making it clear.

Now, go back to those statements I quoted earlier, and see how they drift. Now, you see the drift.
Why not study this in lab rats, and never make it obvious that rats were used?
Now - is this legit? Depends.

It is possible that the genetic variance in non-OCD ppl matches onto OCD ppl? Are the genes in a non-OCD person who scores high on "non-clinical hoarding" also having their influence upon the OCD hoarder? Possibly. But that is way mor efar-fetched than this study assumes. This study has little problem tying the two together tightly.

Consider this: just as we non-OCD ppl vary on washing compulsiveness, within a normal range, and we vary, within a normal range, on hoarding proclivity, we vary on height, and on forehead size.
If the taller among us share genes, does that mean that gigantism is caused by those genes?
Probably not. Gigantism is probably an injection of some other factor that makes that person uniquely different. A phenomenon beyond our normal height range.

If there is shared genes among those of us with bigger foreheads, does that mean elephantitis, like the Elephant Man, is a problem of those genes? No. The Elephant Man had something distincly differnt going on beyond what is going on for those of us with larger foreheads.

Ther is something distinctly different about someone who has OCD. Those of us with OCD have gone beyond the normal range of  obsessive thoughts or compulsive behaviors. This may or may not relate to normal OCD characteristics. what we do know is that those of us without OCD do not have whatever it takes to make one have OCD - whether our genes are one way or another.

The authors could clue us in regarding how extreme some high scoring people were in this study.
But they commit a major fundamental flaw - with the assistance of the journal's editorial board: the devil is in the details - nowhere so they report the actual scores on the OCD "trait" scale: means and deviations. Nowhere do they tell us whether a score of some level or greater is in the "pretty-darn-high, possibly OCD" level. Nowhere. So, we readers cannot get a grasp of the degree that higher scorers might simply be a bit more OC than the next guy, or whether high scorers are really alarmingly OC.

Not in the noted "online supplemental" info, either.

So, there you have it. If OCD is merely a matter of being a high scorer, as prompted by a strong genetic effect that is also seen at non-clinical levels, then OCD types are genetically different. But if OCD is a matter of some qualitative difference - maybe an additional genetic or environmental issue - then this study is 1. irrelevant and 2. misleading to valuable OCD research. This is at the heart of the matter in this whole study, but is not directly addressed.

They propose to study one thing, but actually study another. With this type of strategy, the field of psychiatry can mislead us abt all kinds of stuff. Now, ppl will be going around saying, "Iervolino found that the subtypes of OCD, including hoarding, are genetically distinct." THe present study speaks nothing to this.

I can't really blame the authors - hey, I need to get published, too. I will publish any half-baked, off-track study that Arch Gen Psych is willing to publish. The journal, however - they should know better.

Tuesday, July 12, 2011

Who Ya Gonna Call, Kramer: Robinson?

OK, the guy who wrote "Listening to Prozac" has made a career off of discussing the use of antidepressants.
He's working at again in the New York Times.

Peter Kramer, "In Defense of Antidepressants."
He notes how sad it is that antidepressants are finally getting raked over the coals in the public sphere, a justice paralleled to the Casey Anthony case, where, sure, we know she is guilty, but the types of evidence used just don't add up to a legal conviction.

Kramer's friends, the psychiatrists, use all kinds of tricks to avoid conviction in the courts of the FDA and the Psych journals. Out here in the real world, we know what is up.

1. We don't get better when we take antidepressants. Kramer knows this. He makes a case for having the pills boost response time in talk therapy. They are so lousy that there is now a huge industry devoted to what pill you should ADD when your pill for depression does not work.
2. We here in the real world have learned, no thanks to the pill pushers, that these pills cause problems. Suicidaility in some, such as Phoebe Prince and many others profiled at the SSRI Stories website
Otherwise, they cause bad with drawal problems - any drug that has that much influence on your brain will be accomodated by your brain, and so withdrawal will upset the balance of neurotransmitters. Stories of terrible withdrawal experiences are legion on the web, and, as Kramer notes, these pills are prescribed so broadly, that us everyday people know better than to buy this line anymore.
I mentioned Kramer's friends. He mentions one of the top five psychiatrists who have been caught with their hand in the cookie jar: sponsored heavily by the money of Big Pharma, and publishing lousy stories.

Robert Robinson.
Kramer says, "Surprised that my friend had not been offered a highly effective treatment, I phoned Robert G. Robinson at the University of Iowa’s department of psychiatry, a leading researcher in this field."

Robinson is now notorious as patient zero in the failure-to-disclose controversy that took JAMA from the magazine racks in the medical library an onto the grocery store check-out line. After Robinson published in JAMA a sales-brochure touting antidepressants - certain antidepressants - as treatment for post-stroke depression, it was revealed that Robinson had been on the payroll of that drug's manufacturer, Forest, but not disclosed as he ought to have, per JAMA policy, as well as plain ethics.

"Harris G. Top psychiatrist didn't report drug makers' pay. New York Times. October 3, 2008."

(I think Robinson claimed that it was an ovesight, or he did not understand the form, or something like that - oh, here is the lame response...NEVER connects escitalopram with Forest-)
The JAMA editor, DeAngelis, got involved with at least TWO editorials devoted to the firestorm. At first, she tried to tell everyone to shut up.

AND JAMA collaborated with a handful of other leading journals to commit to new, improved disclosure standards AS A RESULT OF Robinson's unethical behavior.
All of this launched by Kramer's buddy, Robinson.
I hope Robinson shared some of that pharma cash with Kramer.
So, Robinson is like the last guy to call if you want to get the low-down on antidepressants for post-stroke.
On top of all of that, I revealed in a blog post back then a handful of SIGNIFICANT shenanigans that were involved in that "PostStroke Depression" study. I am not widely read. Along with my blog post, I tried to spoon-feed this story to a few other places, but no one picked up the as-yet unrecognized garbage science in that study, and treid to hold Robinson, or JAMA, to task for it.

What I exposed then, in brief, was 1. that Robinson had pitted an under-patent drug against talk therapy to prevent post-stroke depression, but that the talk therapy did not use licensed counselors, so it was an illegitimate comparison intervention - but still fared pretty well, not-far second place! 2. there was yet ANOTHER drug -nortriptyline - NOT under patent - in the trial, but that was 100% UNreported 3. There was yet another drug - citalopram - in the trial - but not reported, but just going off patent, AND the trialed drug, escitalopram, just getting FDA approval!

This monkey business was conducted by Robinson, the guy who Kramer just called for medical advice regarding antidepressants.

Monday, July 11, 2011

Phoebe Prince: Media Loves Bullying, Forgets SSRI Warning Label

Here in America, we are still clueless.There it is on the warning label: Antidepressants can cause suicidality in teens.
So, a teen commits suicide. This event is widely covered by the media. As a bullying issue, not as an antidepressant-related suicide.
The fact that this teen was taking a pill that has, on the warning label, suicidaility as a side effect, is never mentioned.
Phoebe Prince. Go look for yourself.

This dude thinks he gets the point:

He doesn't.

Hypothetically, you could google "Phoebe Prince" and "SSRI"  -- would that be too hard? Do we really expect this level of knowledge and professionalism to be present in the Tara Parker-Popes of the world?
Well, let's see where this super-advanced sophisticated NASA technology info search gets us:

I repeat: this is really technical: google the girl's name, and SSRI.

And plenty more.
Adolescence is not easy. You will get bullied. But why add a drug that is noted to increase suicidality?
OK, that is one issue. The bigger issue is: why have no journialists or commentors in the major media picked up on this?
All they have to do is use google.
I know I have education and training far beyond Tara Parker-Pope. But seriously: can't you use google?