Genetic Bias

What I've noticed again and again and again, is that when articles about behavioral and psychiatric 'disorders' state that these conditions have been shown to have a genetic basis the writers fail to provide references to published research which has been successfully replicated. Why not? Isn't that a fundamental requirement of scientific evidence? -- that research findings can be replicated consistently many times over. Without such evidence these claims don't qualify as 'hard science'.

As any regular reader of Scientific American magazine would probably know, geneticists have found that there are complex interactions between different genes on a single DNA strand, between DNA and RNA, and between genes and trigger events in the environment. Nevertheless, plenty of researchers in the field of bio-psychiatry cling to the simplistic notion that they will be able to find unique genes that will explain the existence of vaguely defined psychiatric or behavioral problems. After several decades of such research none have been found that can be relied upon to show up in replication studies by fellow scientists. It's as if they are hoping to find elusive hard bits inside marshmallows.

Take the fuzzy concept of 'schizophrenia' as an example. It's a well established fact that schizophrenia is diagnosed much more often among the urban poor than any other socio-economic group. And yet its incidence is significantly less in blood relatives who live in impoverished rural areas. In 1998, the journal 'Nature' published yet another paper suggesting a possible genetic link to schizophrenia. Once again, as reported in the journal 'Science', follow-up studies failed to find any confirmation.

Some may say "But what about a physical illness like diabetes? Isn't there plently of evidence that a genetic predisposition is responsible?" Actually, no. In 2001, the International Journal of Epidemiology published a research report on diabetes and high blood pressure in African-origin populations: Sick genes, sick individuals or sick populations with chronic disease? A group of medical researchers from the United Kingdom, France, Cameroon and Jamaica investigated the evidence for and against genetic 'causes' of type 2 diabetes. Here are three quotes from their commentary on the research data:

(1) "Our conclusion is that environmental factors play an overwhelming role in these genetically similar populations, even if that similarity is not yet formally measured."

(2) "We thus favour a hypothesis for the emergence of type 2 diabetes of acute-on-chronic energy imbalance, which has the profound implication of being reversible without 'labelling' currently afflicted societies as 'genetically susceptible', a potentially dangerous form of investigator bias."

(3) "To date, if at all, candidate genes have been weakly and imprecisely related to chronic disease phenotype when they occur. This is despite many millions of dollars spent in research funding and years of searching, which might also suggest publication bias."

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Emotional Ill-Health or Mental Illness?

In 2004, The Royal Australian College of General Practitioners (RACGP) commissioned a review of burn-out and psychiatric illness among doctors. The findings were published in a report titled The Conspiracy of Silence: Emotional Health Among Medical Practitioners. It says patient care, particularly in mental health, may be compromised by emotional illness in doctors. For the most part, the report talks of 'emotional ill-health'. It gives the impression that the label 'mental illness' is a term doctors reserve for patients. The three-part report was originally distributed as a PDF document on the RACGP website (newspaper article: GPs get sick and suffer in silence).

• Part 1 - How healthy are doctors?
• Part 2 - What are the origins of doctor emotional ill-health?
• Part 3 - Improving doctor emotional ill-health.

From the Summary for Part 1.....

"Psychiatric illness and suicide: There are reports of high levels of depression and psychiatric disturbance among medical practitioners. There is also compelling evidence of an increased suicide risk for all medical practitioners but particularly for female doctors."

From the Summary for Part 2.....

"Medical training: Medical training appears to be a particularly stressful process, not just because of academic demands, but because of the lack of emphasis on interpersonal and communication [skills]. Poor interpersonal support may also fail to provide the necessary emotional skills for subsequent medical practice and self care."

From the main text:

A quote from Part 1.....

"Miller (1997) reports that up to 6-10% of US physicians suffer from a major psychiatric disorder such as schizophrenia, depression, bipolar condition or personality disorders. However, levels of sub-clinical psychiatric disturbance may be higher."

Another quote from Part 1.....

"Psychiatrists report that a high proportion of their patients are doctor's wives and children. For example, Miles et al. (1975) report that doctor's wives present for psychiatric treatment in disproportionately high numbers and that the majority of these patients are seeking assistance for marital difficulties resulting from a dependent, histrionic wife and an emotionally detached husband."

A quote from Part 2.....

"Medical training may be criticised for its focus on the rational and biological issues of health, while it neglects the intuitive and emotional aspects. Training tends to be hierarchical, competitive and grade or success-focused, rather than acknowledging personal feelings and self-awareness. Performance based measures of success may undervalue the development of interpersonal skills. The lack of recognition according to personal and emotional health (both of self and of others) may significantly reduce the medical student's ability to deal with these issues in later practice. The culture of self-denial and altruism may seem appropriate in medical practice, yet taken to an extreme may seriously impede a doctors ability to both stay healthy and deliver quality health care to others."

This is not a new phenomenon. More than 30 years ago the Journal of the American Medical Association reported a study by their own Council on Mental Health -- "The sick physician: Impairment by psychiatric disorders, including alcoholism and drug dependence" (JAMA 223:684, 1973). The report emphasized that a national effort was necessary to identify and help impaired physicians return to optimal functioning and to safeguard patients.

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