Medical Error Interviews

Brian Hughes: Psychology in Crisis - an interview with the psychologist and author

July 18, 2019
Author and psychologist Brian Hughes talks about how bad science and scientists can lead to harming people. Brian connects the dots between bad psychological science and how that can lead to medical error and patient harm.

We talk about an infamous research trial out of the UK and how its very poor methodology - coupled with what has been characterized as fraudulent behaviour by the researchers - has lead to millions of patients around the globe with the biological disease  Myalgic Encephalomyelitis - or ME for short - to be subjected to medical harm, abuse and trauma.

These ME patients are often prescribed ‘treatment’ that is actually contraindicated and  makes them more ill, sometimes permanently disabling them. 

As one ME researcher noted - I’m paraphrasing her - “They came to the doctor with ME. They left with PTSD.”

This bad science by psychology researchers who have built their reputations, their careers and their bank accounts on their fraudulent research and harmful treatment, have embedded medical error on a global scale by negatively influencing health care systems everywhere and misinforming physicians about the biological nature of ME.

Brian’s book shows how bad psychological science leads to an institutionalized and embedded medical error that permeates our health care systems world wide.

Brians' website
Brian's blog
Brian's book on Amazon
Brian on twitter
Brian Hughes Show Notes
Psychology is science
Brian born and raised in rural Ireland, small town of less then 2,000 - in '70s Irish economy weak so education considered very important - Brian bookish and good at school and stuck with it - attended university for humanity and arts, psychology degree
Ireland was conservative and psychology a little 'new age' - but for Brian, psychology had philosophical and science bent and novelty - interested in human nature, culture and diversity in spite of small town upbringing - curious about presumptions and assumptions - liked that psych is science and evidence based - became passionate about psych
Brian views psych as science of behavior, broadly defined - being a good psych clinician doesn't automatically make one a good scientist - Brian's area of research focus influences clinical psych like emotional, cognitive, physical stress - especially on cardio vascular and immune health
Brian motivated by the evidenced side of psych research - interested in prolonged stress effect on cardio vascular system because sustained emotional stress will have quantifiable measures in body
Calling out colleagues
About Brian's book - Psychology in Crisis - psychology is interesting because it is tempting for all humans to dabble in psych - like to discuss other's behaviour, social problems, decisions - attracts a lot of lay person effort - but some psychologists have succumbed to lay interpretation - psych is only valid with science and lay interpretation is undermining the psychological field
Working title was 'Psychology's Methodological Crisis' - but Brian acknowledges it is not snappy but is ambiguous - but "Psychology in Crisis" is a compelling title
A lot of clinicians frustrated by lack of prioritizing evidence based practice - likewise, a lot of academic psych researchers that are tolerant of looser approach - Psych is a discipline with a wide range of scientists - at one end are hard scientists, and the other end are the hard anti-science at the other - and lots of psychologists in between - lots in health psychology where evidence is not top of their agenda, helping people is - and that is the enemy of good science - the road to hell is paved with good intentions - and that interferes with good science
A lot of psychologists involved in physical and medical problems and they are committed to helping people - but the risk is that because rushing to help people undermines good science - area of health psychology is not good science - Brian became quite concerned that only a minority take evidence based approach and not interested in scientific rigor - classic dilemma between slow reliable process vs fast unreliable process, and a lot of psychologists choosing fast and unreliable
Bad Scientists
Brian's book received a lot of attention - public response has been supportive and featured well around the world - in terms of academic psychologists, feedback have been positive, some conspicuously quiet, others written privately to support his work but criticize him for pointing out their lack of scientific rigor - but book praised throughout
Writing about risk of assuming we've dealt with psych crisis - asked to speak at conferences globally - generally, Brian is happy how book has been received
PACE Trial is a research study conducted over multiple years attempting to treat ME, a condition that is very debilitating - the concept was that providing treatment that included a behavioural and cognitive component, namely CBT (cognitive behavioral therapy) and GET (graded exercise therapy), would improve lives of people with ME - done in UK, over 600 participants and the authors claimed they had successfully treated ME patients
What is controversial is that on one hand it seems implausible because exercise therapy is reported to be harmful by patients - many psychologists when they saw the results of the study were curious as to what the details looked like - the PACE Trial proven to controversial and beleagured because of the methodology used has been severely critiqued - Brian reports on many flaws in study and Brian concludes it is a weak study and the conclusions are not appropriately grounded and some of the flaws are destructive to good science and an example of how science can damage people's lives
Biggest problem with PACE Trial is its conception - based on asking participants how they feel about intervention, so subjective reports by patients - any study that intervenes with patients should be 'blinded' so patients do not know if they are receiving treatment or not, but in PACE patients were told they would receive therapy, told therapy was good, told therapy was evidence based, told therapy is effective - then asked how they feel about the therapy - problem is therapy is based on teaching patients how to find benefits from situation, to talk about predicament in positive way, so by end of therapy they'd been taught to describe jar as half full
Clinical Amateurism
Basically particpants were biased to report improvement that made the results look like therapy worked - so blinding not used, when blinding is required - and subjective data relied upon when it should not be - this is an elementary problem that is taught if 1st year psychology courses - example of how study should not be designed
When data eventually scrutinized by independent researchers, there were hints the data that if objective measures used, the therapy would have been ineffective - test of physical endurance showed no improvement - analysis of disability payments were higher after therapy - no objective evidence of recovery, only subjective reporting
Mutliple millions of Pounds of money committed before research carried out - would hope grant approval process had competent individuals assessing funding applications - seldom case that people deciding who gets funded try to root out bad research - they rarely test the competence of research designers, not scrutinizing quality of studies
Also, peer reviewed research in the UK have to assume that high profile applicants that applied would've been known to study grant awarders
The Triumph of Emminence Based Medicine" blog post by Brian - an opinion piece - relates to very important researcher automatically seen as reporting quality work and considered bad manners to question the quality of this very important researcher by grant awarding bodies, by practitioners, by people who are conflict adverse and don't like people criticizing very important people - PACE Trial is example of Emminence Based Medicine
The R Word - Retraction - has not been retracted, has produced 2 papers and are not being considered for retraction - not every bad study is retracted - 100s of 1000s published every year, and number get retracted is very small - retraction is unusual - PACE Trial defendors are digging in and trying to promote therapy despite controversy
A lot of people criticize the PACE Trial, Brian simply reporting on what has transpired - no risk to his own career since he's promoting scientific rigor - consensus is PACE is example as bad trial, it appears in text books as example of bad science - only PACE researchers are defending their research
Psychologizing the physical
Interesting cultural divide between US and UK - in US ME declared physical illness, but in UK ME declared as psychological illness - 2 different approaches tell a lot about social contruction of ME, it is a difference of opinion, not a difference of fact.
BPS = Bio Psycho Social and other psychosomatic terms: can have BPS explanation of any thing - originally BPS a sophisticated idea about where and how illness happens - however, replacing biological with the psycho-social is a fallacy - trend some psychologists believe don't need biological and try to define a physical illness in purely psychosocial terms - not really BPS model, just PS - a runaway train, out of control of reasoning - not unlike how psychoanalytic / Freudian view has taken hold in some countries and it is very hard to shift even when facts are known - try to psychologize everything
Some countries, some societies have completely dispensed with psychologizing the physical, but in the UK currently the idea has currency
Look at psychology as a whole - research methods seen key, very important - cannot have psych research without quantitative data - Brian promotes evidence based science and research - need to be assertive in promoting rigorous methods - providing empirical evidence of higher rigor - public realizes evidence is valuable, but we need to explain there is different types of evidence, good evidence and bad evidence - signs people in wider culture are internalizing those values
The volume of research produced annually is a commercially driven industry - university is looking at ranking of how their staff is publishing - the volume of bad science getting bigger every year - but Brian predicts people will approach science with degree of caution because of preponderance of bad science - but we're also becoming more conscious of this problem that bad science exists - now much wider understanding good and bad science
People in psychology arguing for rigor are being outnumbered - but greater awareness of problem - Brian's book one of many discussing crisis in psychology and spreading more widely
Greater awareness of science generally - climate change, vaccinations controversial science - risk of creating world where we don't trust any research and go back to 15th Century when important rich people decided what was fact - consensus is that the earlier we teach people about science, they'll be innoculated against problem of anti-science scepticism - question is how do you get that into the system
We benefit from more science, not less
Vaccination controversy psychologically interesting - always been vaccination skeptics - trend in society for many years of approaching science with caution - not beyond possibility that society will destroy itself - nuclear war, climate change, pandemics, politically
We benefit from more science, not less - more rigor, not less - more care, not less - more time, not less in science - fear that society will leave science behind as unneccessary - but scientists argue for good science but first get our own house in order and make sure science we do we're happy to present to the world and be proud of
Brian looking at human individuality and diversity next - when looking at individuals we understand population better - challenge for psychologists is to look at individual differences, and only a minority look at that - most psychologists look at humanity as a general thing in humans in general - only some look at individual differences - looking at social attitudes and views of people and how that translates into social problems - rise populism, zenophobia, sterotyping minorities, all of these are lay psychological theory
How we get these theories and what does science say about them is the bridge Brian would like to research - explains to wide audience what we know about human diversity and why its important in evolutionary terms
Interested in how science industry work and how do we come to our current understanding - example, lots of stereotypes of how different races behave - Brian is interested in how culture stereotypes influence sciencitific review and the end science and lead us to a world where we churn out bad science in favour of cultural stereotypes - another example is gender differences and why so much research in the industry conforms to prior assumptions instead of challenging assumptions.
Psychology overlaps with a lot of areas, and crisis in psychology cuts across other areas: medical, pathology, epidemiology, etc - psychology can be ahead of the pack in dealing with these issues and sorting out these problems - and they occur across the sciences - if get psychology crisis corrected, can make a big influence outside of psychology
So many people working on this problem that Brian is hopeful for the future.
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