MAHA vs The Lobbies

The lobbies are winning

These posts examine modern psychiatry from a critical point of view. Unfortunately, mainstream psychiatrists usually react badly to any sort of critical analysis of their activities, labelling critics as “anti-psychiatry,” whatever that is. Regardless, criticism is an integral part of any scientific field and psychiatry is no different. As it emerges, there is a lot to be critical about.

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For months, US President Donald Trump has been saying he doesn’t like how Americans pay, on average, more than four times the price for branded drugs in other G20 countries. From Oct. 1^st, branded drug imports will be charged 100% tariffs unless their manufacturers agree to build factories in the US. In an editorial (paywall), this week’s Economist looks at his latest effort, something called “TrumpRx,” a website that will offer discounted drugs, only to find it too disorganised to offer much more than over-blown promises. However, their editorial concluded that he probably wouldn’t achieve much because a lot of the price differential comes from all the other people with fingers in the drug pie: pharmacies, hospitals, insurance companies and so on. That would be inconvenient but it won’t affect what they approvingly called “the gulf in treatment,” i.e. that US health services are tops. Similarly, in her letter to the Senate subcommittee regarding her cousin, RFK Jr, Caroline Kennedy said: “ The American health care system… is the envy of the world.” Americans are shocked to find out none of this is true.

Who do we believe? By all measures, American health standards are lower than practically every other country in the G20. Standards of health for the wealthy and insured are high but those of the poor and uninsured are woeful and getting worse. Average Australians are measurably healthier than their US counterparts at substantially less cost. The US spends about 18% of GDP on health, compared with Australia’s 8.5%, and the same is true of practically every other Western country. With Trump’s botched Covid response and the opioid “epidemic,” their life span has actually gone down in recent years. There is a “gulf in treatment” but it’s the other way around: the US is on the poor side. There are so many things wrong in that country that you wouldn’t know where to start. Medical bankruptcies, for example, are so common as to be normal while 10% of the population, soon to be more, have no health insurance.

However, and despite Ms Kennedy’s brave effort to expose her cousin as a “predatory, drug-dealing, grandiose and incompetent amateur” (anybody who supports him should read it), Mr Kennedy got the job to Make American Healthy Again (MAHA) and feels fully qualified to sort out the mess. Mr Trump is doing his bit to help by pronouncing that paracetamol (aka acetaminophen) during pregnancy causes autism (nobody else agrees). Early days of the MAHA regime are not encouraging: they cancelled huge numbers of short and long-term research projects, as well as many surveillance and commuity treatment programs, forcing expert staff to resign. For example, one of Kennedy’s main targets is the immunisation program. He sacked the 17 highly-qualified members of the Advisory Committee on Immunisation Practices (ACIP), replacing them with a mix of loyal amateurs and idiots, including a Dr Robert Malone (paywall), a medical practitioner who has never seen a conspiracy theory he thought was too extreme.

As mentioned a couple of weeks ago (Substack Sept. 16^th), the “health care strategy” for children (Make Our Children Healthy Again, MOCHA) has now been released (if you open that link, note the imposing red banner proclaiming the current government shutdown as the work of the dastardly Democrats; never let a crisis go to waste, as they say). I found the “strategy” very long on hopes but short on facts and concrete plans:

As for weaning children off junk food, getting them off their screens and off their couches to run around the local park without being poisoned by chemical pollution, I agree with him but good luck with it as the lobbies are armed and ready.

Just as a reminder, the Kennedy team has decided the four demons of child health are: Poor diet; chemical exposure; lack of physical activity and chronic stress; and overmedicalisation. To counter them, the strategy indulges in 20 pages of bureaucratic waffle. Even the AMA journals felt moved to publish a list of the strategy’s many failings. They echoed my sentiments, albeit somewhat more politely, pointing out that changing policy is much more difficult that issuing high-sounding reports. This is especially true given the power of the many lobbies involved. Why does that matter? Why do we care what the Yanks get up to? Because unfortunately, what happens in America doesn’t stay in America, it spreads. With that in mind, I see a huge problem for anybody hoping to change their immense ($4.3trillion a year) health industry, which affects every living soul in the country.

One would expect that questions relating to the declining standards of health in US children should be resolved by a polite exchange of scientific facts, However, because of the people involved, that’s not going to happen. First question to answer is whether children’s health standards are actually dropping, and the answer appears to be Yes. For mainstream medicine, that’s not very difficult. Children either have pneumonia or diabetes or cancer, or they don’t. If these rates are changing, there should be answers because the science involved is beyond reproach. If the report says “Child has neuroblastoma,” that’s it, don’t argue. We can argue about the cause but disputing the reality is of the same order as disputing any other scientific field. Mainstream medicine and all modern technology spring from the same scientific conception. If you use a computer or smartphone, travel on jets, have an operation, etc., you are putting your life in the hands of people trained in a very narrow view of science, the positivist view. We do this all the time without so much as blinking, to the extent that most of us would probably not survive in a pre-modern world. Modern medicine is part of the same positivist, scientific program. Arguing with it is like trying to argue that satellites don’t exist.

Before we talk about Mr Kennedy’s favourite itch, immunisation, can we be clear that the word vaccination (from vacca, Latin for cow) applies only to the inoculation of live cowpox virus to prevent the deadly disease, smallpox. This program eradicated smallpox and, in my view, should never have been stopped just because there are still two stores of live smallpox virus left the world, one in Russia and one in US. If they ever got loose in an unvaccinated world, the deaths would be in the billions. So back to immunisation. The science behind this procedure has come a long way since Edward Jenner first tried it in 1796. The modern science of immunology is breathtakingly complex but it’s just applied molecular biology. The same science that gives us computer chips or PET scans or the internet tells us that mRNA immunisation will work on Covid. Yes, there will be the occasional complication but a similar low level of risk doesn’t stop the “anti-vaxers” from getting on an airliner to travel to a conference. It’s all part of mainstream positivist science. If you trust one bit, you have to trust the lot because mRNA drugs and jets are pages of one and the same intellectual program.

Similarly, the relationship of diet and exercise to chronic conditions such as asthma, bowel disease, arthritis and so on is not conceptually difficult. It’s just a matter of crunching the numbers to get the answers. All of this is routine, just ordinary objective science, and all of Mr Kennedy’s experts are comfortable with it. They all take their blood pressure tablets and have their operations with anaesthetic when needed, and most of them (including one RFK Jr) have had their children immunised. Yes, children are much better off slightly underweight than morbidly overweight. Obese children become obese adults who die younger after a life replete with preventable disease, including misery. If his team can do something about poor diet among children, they’ll all deserve a prize. However, they’re not off to a good start. A body called the High Level UN Meeting on Chronic Disease and Mental Health has just issued a 700 page report compiled by a committee of 19 international experts and 18 coauthors (there is a summary in Lancet, a mere 47 pages long, with a brief outline on p2). 195 countries voted for it, and one voted against it. Guess who?

Three weeks ago, I suggested that when it came to fisticuffs between the Kennedy Mob and the very big lobbies lined up against them, the lobbies would win, even if only by surviving the next few years. Looks as though that was the right call. First blood goes to the lobbies, in this case, food and agriculture. The UN Committee recommended a major change to diets throughout the world, with big reductions in animal protein, sugars, fat and salt, replacing them with high fibre, low-processed vegetable foods:

A diet good for both people and the planet focuses on fruits, vegetables, nuts, legumes and whole grains — a moderate amount of meat and dairy — and very little added sugar, saturated fat and salt,” said commission co-chair Dr. Walter Willett, professor of epidemiology and nutrition at Harvard T.H. Chan School of Public Health and professor of medicine at Harvard Medical School in Boston.

OK, so unremarkable, so what’s the problem? It’s political, of course. American farmers are already on their knees due to the Trump tariffs, as China has stopped buying their soybeans and corn and beef and orange juice, etc. If they’re now told that US consumers must reduce their intake of beef and pork by about 90%, that’s the end of the farming industry and all the votes they (very foolishly) gave to Trump. Remember that the food industry is very big, with vast supply chains that extend down into practically every street in the country. They need trucks, refrigeration units, packaging, railways, electricity and a huge array of chemicals, plus they employ a lot of low-skilled labour. You can’t just switch that off. Of course, the UN Report doesn’t put any time-lines on it but such is the state of US politics at present that if the rural communities, almost all of whom voted for Trump, heard even a whisper of this program, he’d have to flee the country. And as stupid as he may be, he knows that.

So much for the demon called “Poor Diet,” it’s still at large and having a whale of a time. So far, the score is Lobbies 1, Science Nil, but remember, that’s for a program with a solid foundation in science. What happens when they take aim at the explosive increase in psychiatric diagnoses among American children? Will they say “Yes, we agree with all these diagnoses but we need to find a cause,” or will they take the firm line of pointing out that so-called genetic illnesses cannot increase by 500-800% in one generation, that there’s something wrong with the “science of psychiatry”? My bet is they’ll fold, their bluster and bold plans will fall silent and we won’t hear much more about it. Kennedy’s problem is two-fold. In the first place, and although he doesn’t know it, the explosive increase in diagnoses of chronic mental disorders has no basis in science. There is so much wriggle room built into the DSM diagnostic criteria that it doesn’t matter what he says, the psychiatrists will just shift their grounds ever so slightly and they’ll win the argument. If it happens that he shows that each and every claim they’ve ever made about ADHD and ASD and transgender children, etc., is wholly wrong, they’ll just laugh: “Yes but we’ve got new results that prove we’re right.” Mr Kennedy and his committee will be lured into yet another game of Academic Whackamole that they can’t possibly win.

The other reason he can’t win is the 40,000 psychiatrists who have devoted their careers to diagnosing and treating these disorders. There is no way they will suddenly admit that they’ve got it all wrong, that a bunch of non-medical people have finally cracked the mystery of mental disorder. That doesn’t happen. Professors do not, under any circumstances, hand the microphone to an upstart. They would rather cut their tongues out with a rusty knife than admit they’re wrong. I’ve probably mentioned the case of Dr Harold Bourne from England who, as a registrar (trainee) in 1953, showed conclusively that the very popular insulin coma treatment for schizophrenia was both very expensive and useless [1]. The professors, including Sir Martin Roth, president of the Royal College of Shrinks, were incensed, they couldn’t believe that Bourne’s figures were more reliable than their “clinical judgement.” They arranged for him to get a job in New Zealand and kept on using and teaching insulin treatment until they fell off their perches. That’s academia for you, but it’s worse in psychiatry because they don’t have a model of mental disorder to set limits on their activities. They can keep inventing diseases until the cows come home, nobody can say they’re wrong, so that’s what they do. When the pseudoscience of Kennedy’s team of amateurs runs into the pseudoscience of psychiatry, we would like some good to come of it but mark my words: the professionals are going to win. Plus they have huge lobbies behind them who deal in the only currency Trump understands, votes and donations.

What will be the outcome of this brawl? I don’t know but I’m sure it will make no difference to anybody on the ground. The drug companies will continue making money; psychiatrists will continue over-diagnosing and over-prescribing (and making money); academics will contine telling everybody they’re on the cusp of great breakthroughs in treating mental disorder but they need more money; hospitals will continue locking people up and forcing them to take drugs that shorten their lives; more and more people will get more toxic drugs they don’t need and can’t stop; Trump will drift further and further into befuddlement; in the scrum to inherit the Trump mantle, the eager young bloods in his cabinet will sideline the elderly RFK Jr; and the news cycle will forget the UN Report in a matter of hours.

That’s pessimistic, isn’t it but it flows directly from the spurious notion that objective science doesn’t talk about things that it can’t measure, such as the mind. Psychiatry’s way of dealing with this is to say that subjective talk (e..g. “I feel so sad”) is just signalling brain problems, it’s code for “There’s something wrong with my brain,” at which the psychiatrist reaches for the prescription pad.

Much as I would like to see Kennedy fall on his face, he’s right on this point: society certainly is over-medicalised and over-drugged. It has to be corrected but he won’t do it. The correct approach to this very real problem is to broadcast that psychiatry is flying blind, they don’t have their biopsychosocial or biomedical models to guide them, that it’s all made up. Change will not come from within psychiatry, it will only come from external pressure. This is no time to give up.

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The justly-renowned, pioneering primatologist, Jane Goodall, died last week. Her book, In the Shadow of Man (1971) is essential reading for anybody with an interest in mental health – or in human affairs. A few months ago, she recorded an interview, to be broadcast after her death, in which she suggested that Messrs Musk, Trump and a few others should be the first to go on one of Musk’s spaceships to colonise another planet:

“In the dark times that we are living in now, if people don’t have hope, we’re doomed.”

Reference:

1. Bourne, H. (1953). The insulin myth. Lancet. ii. (Nov 7 ) 265 (6798): 964–8.

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My critical works are best approached in this order:

The case against mainstream psychiatry:

McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. Amazon (this also covers a range of modern philosophers, showing that their work cannot be extended to account for mental disorder).

Development and justification of the biocognitive model:

McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge. At Amazon.

Clinical application of the biocognitive model:

McLaren N (2018). Anxiety: The Inside Story. Ann Arbor, MI: Future Psychiatry Press. At Amazon.

Testing the biocognitive model in an unrelated field:

McLaren N (2023): Narcisso-Fascism: The psychopathology of right wing extremism. Ann Arbor, MI: Future Psychiatry Press. At Amazon.

The whole of this work is copyright but may be copied or retransmitted provided the author is acknowledged.