COMMENTARY

The Death of the Medical Expert?

Ronald W. Pies, MD

Disclosures

August 19, 2013

Introduction

Are you considered a "medical expert," Doctor? Don't be too sure. You may have been replaced by a sociologist, a psychologist, a professor of English -- or even an online "chat room." I learned this just the other day when a well-known sociologist confidently declared that, "...it may be best to avoid drugs in the treatment of depression, or at least use them no more than 3 months."[1] I was impressed by this writer's precision -- why 3 months and not 2? -- notwithstanding his abject lack of medical training and the absence of any credible evidence in support of his recommendation. In my field of psychiatry, I often read similarly confident pronouncements from persons who wouldn't know the inside of a medical school from a shopping mall yet who propound confident statements about psychiatric disorders all the time; for example, the professor of English who discounts the existence of social phobic disorder,[2] the journalist who argues that antidepressants worsen the long-term course of depression,[3] and the well-respected historian who expounds on the proper pharmacotherapy for different types of depression.[4]

These nonphysicians have a perfect right to their views, of course, and sometimes I even find myself in partial agreement with them. For example, there is modest, preliminary evidence that a subset of patients taking antidepressants for many years may develop delayed "dysphoria," possibly related to the medication -- though, absent controlled studies, this possibility is hard to disentangle from the natural progression of their depressive disorder.[5,6]

And yet, it seems to me that we have witnessed a kind of false "democratization" of science, such that, on the one hand, there are very few recognized -- or, at least, unchallenged -- medical "experts"; while, on the other hand, nearly everyone is now an expert. These paradoxical trends have been very pronounced in psychiatry, where everything from the reality of mental illness to the legitimacy of psychiatric treatment has been subject to deep public skepticism, if not outright contempt.[6]

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