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Is evidence-based psychiatry a quagmire?

Published online by Cambridge University Press:  02 January 2018

Zekria Ibrahimi*
Affiliation:
Coombs Library, West London Mental Health Trust, Southall UB1 3EU, UK. Email: ibrahimizekria@googlemail.com
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Abstract

Type
Correspondence
Copyright
Copyright © The Royal College of Psychiatrists 2012 

Evidence-based medicine in general often feels like a quagmire. Reference WallaceWallace (2011) addresses the perils and pitfalls of evidence-based psychiatry in particular. Going through journals such as The Psychiatrist and the British Journal of Psychiatry, a nervous reader might become bogged down in the statistical methods. Twenty years ago, t-tests and ANOVA were common; today, we have SPSS computer programs and all the baffling complexities of logistic regression and factor analysis (Reference Howitt and CramerHowitt 2008).

What articles such as Wallace’s attempt is a perhaps impossible task – to make the ultra-complicated welding of mathematics and medicine comprehensible.

Statistics, as much as theology, is prone to internecine debate, with different contingents disagreeing over the concepts involved. Wallace refers to both P-values and confidence intervals: nowadays, the former have been replaced to a large extent by the latter (Reference Gardner and AltmanGardner 1990). Wallace’s statement that the ‘number needed to treat is regarded as the most useful measure of the benefit of a treatment’ is open to debate. The number needed to treat is still embedded in some controversy, and many prefer to rely on the underlying absolute risk difference.

So how much is evidence-based psychiatry like hazardous quagmire? Numbers and data per se are not enough. The psychiatrist without emotional insight and an intuition of the heart regarding each individual patient is a bad psychiatrist. Forcing psychiatry into the mould of the computer through statistical methods is not always for the best.

References

Howitt, D, Cramer, D (2008) Introduction to Statistics in Psychology (4th edn). Pearson.Google Scholar
Gardner, MJ, Altman, DG (1990) Statistics with Confidence. BMJ Books.Google Scholar
Wallace, J (2011) The practice of evidence-based psychiatry today. Advances in Psychiatric Treatment 17: 389–95.Google Scholar
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