The case against evidence-based principles in psychiatry

Area of Science:

• Psychiatry
• Evidence-Based Medicine

Background:

• A movement promotes evidence-based practice (EBP) as the standard of care in the US.
• The applicability of EBP to psychiatry is debated due to the nature of psychiatric diagnosis and research.

Purpose of the Study:

• To examine the psychiatric diagnostic system, clinical trial data validity, and their application to clinical practice.
• To critically evaluate the foundation and outcomes of evidence-based psychiatry.

Main Methods:

• Analysis of the psychiatric diagnostic system's reliance on consensus and imprecise criteria.
• Evaluation of clinical trial methodologies, including outcome measures, blinding, and reporting.
• Assessment of financial influences on research and treatment selection.

Main Results:

• Psychiatric diagnoses are based on consensus, not experimental evidence, and lack discrete categories, evidenced by high comorbidities.
• Clinical trial outcomes are often measured by symptom reduction, not remission, and data is flawed by design, execution, selective reporting, and unblinding.
• Financial interests impact study design and favor patented treatments, while negative outcomes are often omitted.

Conclusions:

• The current evidence-based psychiatry model is unsound, potentially dangerous, and best considered an untested hypothesis.
• The diagnostic system, data gathering methods, and financial factors create a misleading and harmful system in evidence-based psychiatry.