Is Evidence-based Psychiatry Ethical?, by Mona Gupta
Recent debates about antidepressants probe three possible explanations for the effectiveness of these medications: They are effective because their active component has specific and targeted psychodynamic action (this is most commercially interesting claim), the placebo effect is responsible for the medications’ effectiveness, or the drugs involve some unknown mechanism of action that provokes a nonspecific altered mental state alongside with a placebo effect (Gupta 2014, 59).
The psychiatrist and bioethicist Mona Gupta notes, “All three interpretations are plausible, but none is self-evidently true or false” (59).
Now, if that is the case, then the psychiatric community has the prerogative to determine which is most likely. Professional and financial interests tend to balance the choice toward the first explanation, which presupposes specific antidepressant effectiveness.
Rated as one of the top 15 breakthroughs in medicine over the last 150 years, evidence-based medicine (EBM) has become highly influential in medicine. Put simply, EBM promotes a seemingly irrefutable, principle: that decision-making in medical practice should be based, as much as possible, on the most up-to-date research findings. EBM has been particularly popular within psychiatry, a field that is haunted by a legacy of controversial interventions. For advocates, anchoring psychiatric practice in research data makes psychiatry more scientific valid and ethically legitimate. Few, however, have questioned whether EBM, a concept pioneered by those working in other areas of medicine, can be applied to psychiatric disorders.
In this groundbreaking book, the Canadian psychiatrist and ethicist Mona Gupta analyzes the basic assumptions of EBM, and critically examines their applicability to psychiatry. By highlighting the basic ethical tensions between psychiatry and EBM, the author addresses the fundamental and controversial question - should psychiatrists practice evidence-based medicine at all?
Find the book at the website for Oxford University Press: