Peer review and the construction of knowledge: antidepressants & philosophy.

baddest yen if there is one article if
there's just one person who's a critic who points to a flaw in the basis of evidence used by all of the other articles then that one article invalidates all 50 articles if there's one article that points to a methodological flaw that is found in the other 50 articles you can't treat them equally you can't take an average of the findings you have to actually understand in a narrative way how did we start with this thesis how do we come to this conclusion how do we know what we know how do we put the facts together peer review is not what you think it is peer review means that I've managed to find maybe two or three people who will glanced over the essay and say yes this is worth publishing peer review is not editorial it doesn't mean someone has gone through as an editor and in fact checked my claims a peer review is fundamentally a system of censorship it's not a system of Socratic dialogue or debate it's a peer review is not even as thorough as if I took my ideas and presented them verbally to a group of people who are inclined to to criticize and cross-examine what was going on in the paper so I mean it's just a peer review it's not that it's evil but it is really not what people think it is the function SSRIs were supposed to have and that unnatural began's still to this say day is unscientifically pseudo scientifically claiming the original thesis was that depression linked to low levels of serotonin right and that therefore SSRI drugs would augment Puddle increase serotonin levels in the brain that has been debunked that is pseudoscience and she is seriously recommending that more people do the irresponsible ignorant self-indulgent thing that she's doing and not read the kind of sources of so do not rejoin a montcrief not read Peter Breggin country experts in the field to devoted their lives of this and publish many books on it not read the peer-reviewed or even again even if so again this comes back to my thing about Buddhism even if the one article I read you guys at the start of my last video I read that in three minutes even if that was the only source of its kind which it's not if there was just one article that invalidated the evidence base and the methodology of the other 50 articles then that one article is enough that tells you what you need to know if you are a skeptic let's all look in the mirror and think about what what skeptic means peer review doesn't mean that people are lying Buddhists lie in peer-reviewed articles about putting some Catholics lie in peer-reviewed articles about a polka thoughtless ism I dealt with this before the the meditation articles then get published meditation drills yes people lie in scientific journals sometimes it's because they sincerely believe the lie in the same way that a Buddhist you know may believe they believe yeah yeah to me it's just ridiculous that people who are vegan who are pardon me aware that there have been so many studies published on positive effects of meat and dairy and they are able to think skeptically about it and say that you shouldn't pay attention to these these studies you should pay attention to these ones that advocate for a plant-based diet or at least provide evidence that a plant-based diet is healthier than a typical omnivorous diet so it's like why if you don't trust your doctor when they tell you that you shouldn't eat meat why would you trust them when they tell you that you should get on an antidepressant or why would you trust just the general opinion that from whatever your experiences were like reading online or talking to people people maybe your family members who have antidepressants like why would you take that at face value when you know that you're that same family member it's me enduring Starion you know see knowing that like you live with these these own yeah you live with scientifically unpopular opinions I mean poor that way your opinion is against what you could call the consensus in science [Music] about us yen when I first came up with the topic for this video I was highly motivated and full of life and energy to record the video and man jetlag caught up with me and would be exhausted and drained maybe that's for the best because it's a somewhat somber topic for the video there are two different examples linked by this one related overarching issue I want to talk about in this video for me the fundamental issue I want to talk about I think our attitudes towards science and knowledge and the easiest proxy to deal with here is this ghost of peer-reviewed literature peer-reviewed scientific articles so you know I mean look I got so many disclaimers to throw in here I'm going to save this all the time I can't pitch my videos to the stupidest 20% of my audience I got a lot of really stupid emails and some really stupid Twitter messages from people just rejecting the basic premise the basic scientific facts that have been posted on screen in a series of videos dealing with antidepressants and there is no point in my spending my time backing up and demonstrating such simple scientific facts that have been proven in some cases since 1982 in some cases since the 1990s where there are books published and there are indeed lectures from experts here on YouTube you can look up I just don't see that as a productive or worthwhile use of my time now so I'm very very reluctant to address something that I really think only pertains to the stupidest 20% or stupid stupidness 40% even of people who've watched and responded to my earlier video but amongst that stupid or 40% I saw this tremendous self-confidence in taking the average of wrong answers in saying oh well I can look at you know 30 or 50 peer-reviewed article or even whatever 30 and 50 textbooks and I can insist that there were all these peer-reviewed articles there for kind of all of them must be half right and in this case the inference is there for SSRI drugs which I'm mostly going to refer to here as antidepressants that's only one chemical class of antidepressant drugs that therefore the science behind SSRI drugs is good reliable so I'm really gonna deal with two very different examples here in my own life and experience having to do with peer review I guess you can say epistemology or philosophy of science or knowledge or just how we live and know things in the modern world but one of them is from my experience in Buddhist studies you know you'll see where I include this in just a moment now the point I'm trying to make in talking about this example from research into Buddhism is it does not matter if I have 10 or even 50 peer-reviewed articles that a claimed effect notice I'm saying claim here not prove you know you can take an average you can take a census and you can talk about consensus if there is one article if there's just one person who's a critic who points to a flaw in the basis of evidence used by all of the other articles then that one article invalidates all 50 articles I'm gonna go back to that explains a little more if there's one article that points to a methodological flaw that is found in the other 50 articles you can't treat them equally you can't take an average of the findings you have to actually understand in a narrative way I mean I'm using the word narrative you don't have said you have to kind of work up the story of what happened and how and why how did we start with this thesis how do we come to this conclusion how do we know what we know how did we put the facts together say okay so there was an error made here in methodology there was error made here in terms of the actual facts and then you have to analyze the data from the different sources give that finding so one of the controversies I was involved with the Buddhism there are a couple of really crucial fundamental concepts in Buddhist philosophy and in the Buddhist religion that I challenged and whether or not I was the only person to challenge them I mean you have to define only person to challenge it in English in the 21st century or something I did look around for other examples of other Buddhist scholars who had kind of sort of made the same point in most cases you could find trace of other people who recognized the problem sort of hidden away here and there there are many books still today again you can you can take a you can take a census you can talk about consensus of views among scholars and even put as monks one of the most popular foundations of Buddhist philosophy taught in university classrooms taught and puttest temples and found in textbooks and in academic writing is the so called philosophy of interdependence so people normally say the the twelve links of interdependence now this is my point of a peer review I'm sorry I have to talk about this another their video reason what does it mean let's just say there are 50 articles in reality there are more than a hundred articles peer-reviewed articles about this aspect of Buddhist velocity but let's use the number fifty if I have a corpus of fifty peer-reviewed articles published by scholars on Buddhism published by Buddhist monks etc and all of them affirm one after the other that yes there's this text in the ancient Buddhist scriptures and this is what it means philosophically and this is what it says and then I come along and say oh no no the text actually doesn't say that the fact that there are 50 articles the significance of peer review really just is that one Buddhist monk one true believing adherent has presented this to an editorial council of other Buddhist monks of other people who passionately believe in this religion and support its future and the people who call themselves secular scholars within Buddhism it's the same with Christian Christian Bible College you know who goes to Oral Roberts University and gets a PhD in Christian studies or if you want to you want to put it yes there are also so-called secular but of studies journals but the sense in which they're secular is only the same senses in which if you have a group of men who have PhDs in Islam or Christianity you're normally going to be dealing with an incredibly high level of religious bias and research bias just even in the selection process for who will choose to get that PhD who will become the involve the editorial part of that journal and I dunno different journals will have different biases you'd know this right if you just go to an academic library and look at the journals for Catholic studies for one thing some of the journals are going to be interested in the history of Catholicism in Spain some in the history of Catholicism in France there's gonna be a difference there what type of person is involved in those areas of study Buddhism people who are involved in Japanese Buddhism different from another another school Buddhism this is a this is a fundamental assumption about Buddhist philosophy that many people considered to have been proven and I was able to debunk it I think debunk is the word by pointing to the basis in evidence which is to say I could actually read the ancient language Pali and I could point to word by word what the original text actually says and then also I went and did the historical research and I put together the narrative I'm gonna use this word narrative a few times sorry I put together the narrative of how the other thesis ever was constructed how did we get the idea that this text in this ancient Buddhist scripture had this meaning about interdependence this philosophical concept that all things are connected and arising and ceasing to exist and in the mind it's this claim about psychology of things being interdependent and so on now this is not a minor I'm sorry spoilers Oh put a link to something I published on this below but in getting how public is it and this could not try to get this through editorial boards and for journals and foot of studies where again the people are Buddhist monks or their so-called secular scholars who are if anything even more he committed me even harder to shake from their Orthodox news than Buddhist monks it's very very difficult to get this kind of thing out it was not a minor or trivial mistranslation this passage of ancient scripture was not about human psychology at all it was not about a philosophy of interdependence in the sense it was very directly a description of the formation of the embryo of how pregnancy occurs pregnancy and ultimately childbirth and if that seems a little strange to you why would a Buddhist philosophical text talk about this in one word it's because of reincarnation an aspect of reincarnation if you take the re of the front of the word one aspect is incarnation and an important thing in Buddhism so youyou heard me talking just yesterday to Muhammad about this Buddhism teaches that there is no soul and in India when Buddhism was a new religion most of the ideas that people had about pregnancy reincarnation and incarnation had to do with how the soul comes to be inside a body how the soul creates a body or company is reincarnated body and they had to argue but as philosophers when Buddhism was new they had to explain basically where do babies come from and where does the mind come from given they had a model of human psychology and life carnation carnation and reincarnation that did not have a soul so it's an interesting text in its own right what I'm do bunking here is a misinterpretation of the text that in modern times had arisen and was bolted on to a religious text which is thematically philosophically about something totally different and among the the smoking gun evidence for this and I've never once had an academic some with a PhD or a Buddhist monk dispute me on this but what okay I'll give a specific example there was a professor of Sanskrit so not of Palli but Sanskrit which includes put us into some extent Hinduism at a small University United States and when he talked to me about it by email I'll give two examples so professor activist but he was shocked at the hypothesis he was shocked that I had bunk'd an assumption about Buddhist religion scripture and philosophy that was so fundamental and so widespread and that there are definitely more than 50 peer-reviewed sources treating us factual advancing as as as a proven fact and his first response to my email was to say well you know in later Sanskrit sources this is not pally but Sanskrit later Buddhist and Hindu sources you know sometimes there are certain words in Sanskrit that are used in an abstract philosophical sex that people can misinterpret as being sexual so is that the problem here and I wrote back to him and said the key word here is not to could just mean are you actually going to look at the original text and it's very hard to get scholars of this kind to look at the original text not at the English the first language treatment because very often their competence is is much less than one of pretend it is said the key word here is not to could just Ming are you actually going to claim to me that that this is an abstract philosophical contents concept an abstract or self concept and not a literal description of what this ancient Buddhist attacks about so MA to Matthew is cognate with words we have in English and European language like mother works for mother in Latin and Greek all resemble some and coches Ming is actually cognate with some words we still have even in English like Koo Chi as as slang and another European and Indian languages it Matt - cooch is Ming the ending is the locative ending which grammatically means the location of something that one word alone means in the side the mother's womb so no interpretation can actually no psychological or philosophical reinterpretation this text that happened could actually get past this fact um now also sorry there's this narrative element where I went back and looked at okay how did the misinterpretation text ever arise was the original source the original European source that reinterpreted was incredible and the answer is no it's the actual book that did it for is basically a total crackpot book it wouldn't be regarded as a respectable day it was published as a book but it's not not a peer-reviewed book or what have you it's not really a scholarly book just everything about this book and who the author is and someone is not respectable and then you I was able to look at the history of how a thesis that on its own is not credible isn't demonstrated from the source text doesn't have evidence came to be repackaged and recycled in respected peer-reviewed literature and came to be regarded as as a foundational concept of how Buddhism is understood today okay all right why am i right and why is it that 50 peer-reviewed articles are wrong well point one I already made a video but this recently peer review is not what you think it is peer review means that I've managed to find maybe two or three people who will glance over the essay and say yes this is worth publishing peer review is not editorial it doesn't mean someone has gone through as an editor and in fact checked my claims a peer review is fundamentally a system of censorship it's not a system of Socratic dialogue or debate it's a peer review is not even as thorough as if I took my ideas and presented them verbally to a group of people who are inclined to to criticize and cross-examine what was going on in the paper so I mean it's just a peer review it's not that it's evil but it is really not what people think it is peer review simply put peer review does not prove anything except that there is an editorial board that that fundamentally sympathizes with my my biases my right so it was I was gonna mention one other this is the human face of this one other example of how a professor responded to my discovery or you could say my critique of what was assumed about about Buddhist philosophy in this way so this was again a professor at a smaller University United States but this guy was specifically professor of Buddhism and he actually had already claimed that he read my article in this we had a conversation I'm sure he was just being polite but he said the article was brilliant the article I wrote about this but the 12 lengths of interdependence which okay well seemed like you'd read it oh and then he sent me a copy of one of his new essays so something he'd written at that time I've open his flossing and I read it and I said back to him I said well I'm surprised you're still making the same error precisely the error I disproved that the concept of a debunked as false as not based in the public tax this is a misinterpretation of the ancient Buddhist scripture you're using here as a central philosophical concept in your new acid this idea of psychological and depend interdependence and the actual text is about where do babies come from and he was shocked and furious and really he was really really angry now again this is someone who is a secular scholar this is someone who's an academic in a research institution in a university teaching teenagers who pay money to study there in theory this is not a Buddhist monk this is not a religious leader but there's a level of commitment ideological commitment that he was already out when he decided to start his ph.d and that ideological commitment is gonna change and transform when he takes on a sense of responsibility of being a professor being a public figure who talks about Buddhism psychologically someone who's in academic can be even more committed to Buddhism or to a school of thought in psychiatry or some other secular Fuzzy's they can be more committed than a religious fanatic to be honest and you can very easily have an editorial board for a publication which may only be 5 people or maybe three people doing peer review who are again highly highly committed to some to some set of assumptions a with the conversation didn't end there I I think at that point I hope I didn't said oh well you know but I just said again you told me you had already read that article and I quote I said you know I quoted back we said you said it was Brewin I said look I I assume you didn't read it when you have time you know read it and take a look and let me know what you think and he did I think it was about a month later I got it I got a very humble email from him and he said you know you're doing something really important here and I think that in future somebody needs to go back and re-examine all these texts and our assumptions of both I mean it's just like very general he still couldn't kind of concede the specific point that this this very fundamental assumption about about Buddhist philosophy was it was false okay now look you may think that the sciences the hard sciences are very fundamentally different put it this way the structure and construction of truth in the sciences you may think it's very different from the way we assemble and present the truth in Buddhist philosophy or philosophy generally they have some things in common there were some real red flags with the narrative of how the case was made for SSRI drugs that are even in the name SSRI so we were just talking about this melissa you were you were going to take a shower you actually stopped no wait I don't want to hear that see we don't mention this so the actually so serotonin reuptake inhibitors yes no no you're right no so the first s is for selective but the core idea here is that this inhibits the reuptake of serotonin right so the fundamental thesis here about the human mind and about the nature of depression as a disease and about the course of treatment is already built into the the word and it's built into the kind of verbiage that that unnatural vegan uses in describing the conditioners treatment and that the fundamental assumption here is that depression is caused by having too low a level of serotonin before when when you're ill that the illness is prompted by or consists of low levels of serotonin in the brain now so even distribution we're always playing this video and the guy said out loud in the video okay well how do we measure this is there actually evidence that's hot so now what do we have to do we have to see do people with depression have low serotonin before they go on the drugs they begin doing this even before prozac comes to market and they give they don't give people an SSR before they do this initially what do they do what is the science to try to check with people to see if they have low serotonin before their Medicaid well they know this so you can release the serotonin then normally it's broken down into metabolites and so they say we can measure the level of metabolites and their cerebrospinal fluid and if people have low serotonin then they should have low amounts of metabolites in that cerebral spinal fluid you see the indirect measurement so they run such a study in the 1980s and what they find is those metabolite levels are perfectly normal that now they do fall along a bell curve there's some of the low end and there's some of the high end but then you do the same thing with quote normal people and you see the same bell curve and then they also look like well maybe the people who respond to antidepressants are those at the low into the bell curve and their serotonin is being fixed by the drug and what they found then when they put these people on medication there was no correlation between response to the drug and your metabolite levels so in 1984 the NIH says it doesn't look like a problem in the serotonergic system is associated with depression this in 1984 is the beginning of the collapse of the the low serotonin theory of depression three years before prozac is brought to market you nobody's tested on their serotonin levels before they're prescribed right any antidepressant any what and why I mean if you do if you are given drugs for diabetes you are given an essay of tests like well including your blood sugar I mean most obviously we're going to show that you should be well what I mean so this is just linguistically what you're talking about here is a deficiency so if you have a serotonin deficiency why aren't you tested for that and told okay so you a normal person has this much okay another example sorry diabetes is a good example but another one would be say testosterone deficiency right so many men today go in and take a test for what are their testosterone levels and they can compare that to other men's testosterone levels or an average or whatever they can also defer to their own testosterone levels right you can come in to the doctor over a five-year period and get tested for your testosterone levels again and again now if you're a diabetic you're probably testing your blood sugar levels multiple times per day depends on how severe your condition that's actually but you're being tested for your your blood sugar levels many many times over time so the to Venus is the most obvious reflect but which again like whether it's Buddhist philosophy or philosophy of science or medicine um so how many times have you been tested for your your serotonin levels did you test that your levels were too low before and that now they've normalized and then another big example so another red flag that you don't need to be a medical or it again when you quit this drug you go through withdrawal symptoms yeah so much all symptoms more severe than your original depression yes yes yes yeah it's it's very scary but again so are there medical tests that show that that these withdrawal symptoms are related to your your serotonin levels crashing right down that is the theory of depression as disease that is the theory of SSRI even built into the the term and the effectiveness of the drug so will put up a clip for this I don't name whether we've already put it up or we'll put it up right now um but since approximately 1982 1982 it has been scientifically known and scientifically proven that this is not true that the serotonin centered theory is false as a medical fact that when you measure people's serotonin levels this this doesn't correspond to depression anyway now after prozac is brought to market they keep on researching this and they keep on trying to find is there something wrong with the serotonergic system okay maybe the problem is okay it's not that the presynaptic neurons release too little serotonin maybe the problem is those postsynaptic receptor neurons have too few receptors for the drug maybe that's the an normality but they don't find it now here is something from the American Psychiatric Association's own textbook in 1999 that sums up this long search for a chemical imbalance and depression and so what do they say to themselves it says it was first proposed the model Amin hypothesis is the low serotonin and low norepinephrine hypothesis because these are both known as mono amines first proposed in 1965 this is why the drugs work however watches inferring neurotransmitter pathophysiology from an observed action of a class of medications on neurotransmitter activity is similar to concluding that because aspirin causes gastrointestinal bleeding headaches are caused by too much blood loss and the therapeutic action of aspirin in headaches involves blood loss theirs to make their poking fun of the hypothesis saying it was sort of silly from the beginning to just I pathi size that the problem is the opposite of what the drug does now this is as they're telling you you have low serotonin this is in their own textbook it says additional experience has not confirmed the mono amine depletion hypothesis were not finding it to be so who Steve installed he is a molecular psych biology psychiatrist he believes in a you know the brain disorder concept but then he reviews that in his textbook essential psychopharmacology there is no clear and convincing evidence that mono amine deficiency that search energy efficiency accounts for depression that is there is no real mono amine deficit who's Eric nessler I'm just showing you he's considered one of the leading scientists in the world on neurotransmitter activity in general and also how it might relate to cognition and psychiatric function and what does he say in 2010 we have looked at this in every way we can we've depleted serotonin we've looked at genetic associations we've looked at all this there is little evidence to implicate true deficits in any of these neurotransmitters in the pathophysiology of depression and then again he says this is not a surprising finding because there's no reason that the mechanism of action of a treatment is the opposite of disease pathophysiology so you're seeing again here this hypothesis sort of had a false beginning a false rationale you know philosophically again you can squish it it comes down Jewish and also how do you define depression what is depression we all know depression is something in your mind and in your head and loes no I'm happy to talk about my own history of of misery I'm gonna use word misery rather than depression I've never been diagnosed approach but I that incredibly sad times my life but I know my misery is in my attitude in my perception in my thoughts in my feelings and doesn't exist in things themselves neither external nor internal Melissa you were with me during the the period of the death of my father no someone else in some other situation could and I was in China and I got the news by email I think not even by telephone I could completely understand that someone else in that surgery situation would go into a depression it's totally understandable now there are many reasons why that was not the case for me right now I mean conversely I would say the most acute misery of my life which I think could have been diagnosed as depression was when I was at the University of Toronto and it was because of the quality of education there you know what I wasn't a rape victim or something it wasn't something like that it was because the incredibly low quality of education there's is something stronger but of course it's what I'm thinking and feeling about it there were people sitting next to me in the same classroom with the same major who were completely happy right with the same education this isn't an objective reality in that sense of course of course what argument objective reality you know my father really died the education was really of low quality but you know there's somebody sitting next to me who likes drinking beer every night and playing video games and who's just planning to go to law school and become a lawyer it doesn't doesn't really care about politics and he's sitting in the same the same classroom for those eyes and he's and he's fine so you know anyway there are a whole lot of hurdles we leave over here in terms of terms of medicating this but look even if your background is only in philosophy or only in Buddhist philosophy to recognize the problem of moving the goalposts like okay so the original thesis was that depression is caused by low serotonin levels now there's another parallel here so I've mentioned we've mentioned diabetes you know blood sugar levels we mentioned testosterone you know another one for a very long time researchers and psychologists presumed or speculated that transgender sexual dysphoria or they want to say transgenderism would linked to irregular hormone levels that men who wanted us as women would have abnormal hormone levels and enormous numbers of tests were done on this and no the final conclusion is that no the issue of being a transgender person exists in your mind and perceptions and thoughts and feelings it's inside your brain it's not a hormonal abnormality but that was a very natural assumption people led to it may be natural for people to also leap to the assumption that what we call depression is a hormonal condition or it relates to the level of some serotonin it's not hormone but a chemical in the brain that it's a chemical imbalance in the brain right and that was the hypothesis that hypothesis was already debunked in the 1980s not even the 1990s but what did people do and now I'm interesting people because it's not just medical researchers there's a huge part of the public involved and there were a lot of just medical doctors who are not specialists in the same way that your local medical doctor or even your local psychiatrist is not going to be an expert in nutrition like you can have a medical doctor telling you to eat more eggs and bacon they don't really know there are medical doctor but this is not the rate of expertise in the same way there were medical doctors who know a little bit more than laypeople but they're they're not doing this this kind of research for the most part people reacted to this being debunked by moving the goal posts by trying to change the definitions of what was supposed to be proven anyway of what would be confited considered efficacious of what really matters here and they're trying to preserve the narrative despite the fact that the evidence base for it has been debunked or removed so this is something now again this is very much like the religious mentality this is very much like what I encountered in Buddhism when I would debunk common misconceptions of the religion so I've talked about one at some length but yet people respond to this they still want to believe in the story they still wanted to believe in the narrative oh but that's actually not in the Bible that's not in the scripture for some oh so that's just a modern idea people meet up and attributed this oh and the guy who made up the idea isn't a Buddhist monk and isn't a respected scholar it actually comes from this crackpot source that's really not credible oh well we can respond to that by moving the goal posts and creating a new mythology around it come with new justification you can you can but that's exactly the religious mentality not the not a scientific modality not though not the therapeutic mentality so there are a lot of different Russians we can take this in right now I mean you know you know we could talk about our own experience with misery depression unhappiness with attempts to you know cope with it medicate it you know what have you I got I got all kinds of feedback from the last video and again let's not overstate maybe 1500 people have watched the video that's a video that made a big impact on a lot of people and not everyone's stupid again I don't even know if I think less than 20 percent of the people who watched it we're really stupid enough to reject this what again when I'm alluding to as a well proven scientific fact because it is I'm not gonna put myself in the position of trying to prove things that have been so extensively published and researched and that are based on on self-evident evidence you know but we also got people writing in about the ways in which antidepressant medication have destroyed their lives so there's there's a real price here that a price in blood so we got a message okay so let's just pause with one stat we're cribbing this from the same source that we're using some clips up in this video we can put in the original source but you know one of the other ironies here is many people said to me in effect how dare you how dare I criticize unnatural vegan on this when unnatural vegans purpose originally was to criticize another youtuber fully raw Christina for fully raw Christina's very vaguely stated case that diet and exercise will improve your your experience of depression well that may sound like crazy pseudoscience whereas the disease centered model of serotonin reuptake inhibitor treatment may sound like legitimate science prima facie on the surface at first glance that may sound like one is pseudoscience the other is is legitimate science but in this case the exact opposite is true for one thing again the source we're linking to here the video source will probably link to a couple surgeons it goes to the fact that if you if you leave depression untreated no medication at all after one year about eighty-five percent of people will recover anyway this is about an 85 percent recovery rate then within one year and this is very hard for drugs to compete with for a drug to be efficacious it then has to achieve more than that after you're an SSRI drugs do not they do worse at the one-year mark which is another reason why a lot of the studies in favor of them or structure in such a way to just look at the first six weeks of treatment the initial period of response or not won't turn treatment um but we have a study we just we just saw these stats on screens this is fresh mind and it compared after one year treatment with Zoloft so zoloft is an SSRI drugs zoloft prozac these are particular brand names for particular drugs and spots classification particular types of major depression treatment after one year with zoloft treatment after one year zoloft plus exercise offend treatment after one year exercise only only Desai's know its presence and what will put up the stat on screen its results are way better and yet the results are way more positive for recovering for depression just through exercise that may sound ridiculous I'm gonna get and think about it for the Buddhist perspective when I presented my findings which are from my perspective it's easy for me to prove this to you oh hey let's actually read what the text says let's actually look at this from a Buddhist but it may sound like I'm the crackpot when I said oh no this text you think is about human psychology and maybe the fabric of reality is somebody you think it's this really vague cosmic Stephenville philosophy it's actually a description of how the the fetus forms in the embryo it may sound like I'm the one who's being some kind of pseudo scientific Coleman looking for given that those are your your assumptions but I mean you know this is the thing about what is wisdom a large part of wisdom is detachment from your assumptions this is the I mean I'm not such a fan of Socrates Socrates doesn't solve all of our problems but you know the fundamental wisdom being I know my own ignorance I know what I do not know I'm willing to question these things or in question others and so on how do we how do we come these conclusions in the first place yeah yeah ironically fully Roth Kristina's advice won't harm you right I know she wasn't specifically telling people to get on antidepressants but it's dangerous and harmful to get on antidepressants right well ok you know so you've reminded me of something I haven't talked about so one element is the harm and we do have this idea of the Hippocratic oath first do no harm it's a real question how much harm are you doing people by putting them on these these drugs the second is though there's also just this word effect what is the effect of these drugs an effect is different from effectiveness this is why I'm emphasizing this it's slippery you might not you might not catch this my claim is not that SSRI drugs have no effect have zero effect but I would claim that they are ineffective so several years ago when I was still in Canada before I moved to Kunming before I moved amongst you so it's now maybe three years ago I made a video talking about the enhanced placebo effect so briefly here I'm in an earlier video talk about it's a very important concept in science actually none of our No lately to talk about this most people understand the placebo effect so really quickly placebo effect is I give you a pill or a glass of water that does nothing there's no medical effect and then we measure how you recover from the disease how you improve what the effects are and what your perception of your on earth is so it's well known if you just give someone a fake medicine a medicine that has zero effect many people will perceive themselves anyway as having had a medical effect okay but that's not the enhanced placebo effect the enhanced placebo effect is I give you a drug that has real effects but they're irrelevant to your disease that were relevant to your condition right so let's say you have that well actually guess this is a real example let's say you have sinus congestion and I give you a cream that you rub onto your skin that causes tingling so you have a cold you have a flu or something and I give you a cream some kind of minty green but with a real medical element and it causes this sensation in your skin so I've seen this in many different cultures around the world you know where the different kinds of skin treatments for for cold and flu this is the modern was in Cambodia they have an equivalent where they actually take a piece of metal and rub it into your back a local I guess it is made out of eucalyptus or some kind of tree oil and it causes this kind of cold burning sensation and people think it makes their cold better or their flu but their fever better feed fever or symptoms right this has an effect it's not that it's zero effect so what you're gonna feel and perceive about your health is an enhanced placebo effect right no okay so I've already cited this again an earlier video but we have similar Juwanna Moncrief going through and debunking and debunking is the word debunking a scientific study a meta-analysis that was picked up in mainstream newspapers like The Guardian newspaper it was picked up as proving at long last that SSRIs that antidepressants were effective and actually if you know how to drip with the data the exact same data proves the opposite so again this is a little bit like Buddhist philosophy so I'm not gonna go to this I don't feel I need to prove this stuff to you people if you guys can do the reading yourself but you know it showed a difference the clinical effect was 10.8 points out of 50 this is a human created scale at a 50 on that scale 6 points would be that your sleep has improved like you're going to talk to your psychiatrist and say well I was really unhappy before because my father died but you know now in the last 2 weeks my sleeves improve the doctor could then use this scale say ok improve sleep 6 points ok so 1 point 8 points is by the definition of scale not clinically significant it's a tiny one point 8 out of 50 on this particular scale as its structured does not indicate that the drug is working it indicates the opposite that the drug is not working however basically what the newspapers were doing whether cynically or just ed up in confidence was getting excited that there was this tiny difference whether they say this one point ADA rounded off to two points that there was this tiny difference correspond to the drug that really can be the enhanced placebo effect that that's any difference and then beyond that okay when you start talking about side effects so what what you so with three categories here right and Hance will see well effect is category two right then the other effect we're talking about there are very real changes in your brain chemistry quite a bit with these drugs and all kinds of physical and physiological changes right because it's not an even though we talked about the placebo effect it's not a placebo this brings about all kinds of changes in your feeling perception thinking and life and one of the most obvious is the impact on your sex drive your experience of human sexuality and sexual desire which in terms the history of psychiatry and psychoanalysis that used to be a big deal needs to be a major marker of your psychological health whether or not you can engage in sex you know or whether not you're you're neurotic or what-have-you so I just wanna say there's no claim from my part that these things have zero effect the claim is again this isn't my opinion this just proved in terms of where the goalposts originally were the function SSRIs were supposed to have and that unnatural begins still to this say day is unscientifically pseudo scientifically claiming the original thesis was that depression linked to low levels of serotonin right and that therefore SSRI drugs would augment Puddle increase serotonin levels in the brain that has been debunked that is pseudoscience and she is seriously recommending that more people do the irresponsible ignorant self-indulgent thing that she's doing and not read the kind of sources of so do not rejoin a montcrief not read Peter Breggin country experts in the field to devoted their lives of this and publish many books on it not read the peer-reviewed or even again even if so again this comes back to my thing about Buddhism even if the one article I read you guys at the start of my last video I read that three minutes even if that was the only source of its kind which it's not if there was just one article that invalidated the evidence base and the methodology of the other 50 articles then that one article is enough that tells you what you need to know if you are a skeptic let's all look in the mirror and think about what what skeptic means being a skeptic means you don't dismiss that one article I read out the abstract at about three minutes one article that's telling you this is an evidence myth based on misinterpreting and and and very obviously misinterpreting in misrepresenting statistics that rests on laughably absurd definitions of terms that there are problems here and how the narrative is put together in what the evidence is how its misconstrued and misinterpreted even on concepts like statistical significance versus clinical significance that there are methodological errors here and then there's what the evidence base actually actually reflects I've put this up before the star D study showing that that something like only 3% of people in that study sorry surgeon look again this isn't my field but when you're doing long term like one-year analysis not the first six weeks shockingly shockingly low numbers of people actually get to get paws result in this and I've had this stat on screen before and today we heard the same statistic again being reported repeated by another source now this study has starred e-trial is the largest antidepressant trial ever conducted it was funded by the NIH 4041 patients it was conducted in real-world patients and I will tell you the results were so bad they fabricated the results and there's a whistleblower lawsuit it's one of the things we write about in psychiatry under the influence they announced just so you know they announced that 67% of patients there was no placebo in this group the way the study was designed you were put on a drug if you didn't get out well with the first drug you could get a second drug if you didn't get well on the second drug you could try a third and then a fourth you got four tries and what they announced it was that 67% of people eventually remitted it's just not true she actually looked about remission according to the protocol criteria only 38% ever remitted and we go through in the book about all the machination of how they violated the criteria to up that announced rate but here's the key on this this study if you go to the protocol said this study will guide clinical care in the United States because this is in real world patients it's not in what happens is in so many of the FDA studies they only allow certain types of patients in those studies really don't tell us about real-world patients this is going to do it and they said we're gonna have two parts of this study we're gonna show that if you keep trying you can find a drug that works and then people will stay well the whole point is that this will show that people will stay well they paid people to stay in the trial they could adjust the dosages it was real-world care now if you go to the study and they announced the one-year results you almost you just can't make sense of it okay you just can't you look at it you know some data is presented but you can't make sense of it you know why you can't make sense of it no because the study results were horrific out of 4041 patients who entered that study and got four you know had this best clinical care possible there were only 108 who remitted means the depression went away and stayed well and in the trial to the end of one year and by the way the next speaker Irving Kirsch is one of the people who's done some of the analysis of this data so the real stay well rate was less than 3% and people do lie about it peer review doesn't mean that people are lying Buddhists lie in peer-reviewed articles about Buddhism Catholics lie in peer-reviewed articles about about Catholicism I deal with this before the the meditation articles then get published meditation drills yes people lie in scientific journals sometimes it's because they sincerely believe the lie in the same way that a Buddhist you know maybe we've yeah yeah to me it's just ridiculous that people who are vegan who are pardon me aware that there have been so many studies published on positive effects of meat and dairy and they are able to think skeptically about it and say that you shouldn't pay attention to these or these you should pay attention to these ones that advocate for a plant-based diet or at least provide evidence that a plant-based diet is healthier than a typical omnivorous diet so it's like why if you don't trust your doctor when they tell you that you shouldn't eat meat why would you trust them when they tell you that you should get on an antidepressant or why would you trust just the general opinion that from whatever your experiences were like reading online or talking to people people maybe your family members who have antidepressants like why would you take that at face value when you know that you're that same family member it's me enjoying Starion you know seeing knowing that like you live with these these own yeah you live with scientifically unpopular opinions and you can pour that what your opinion is against what you could call the consensus in science why wouldn't you well why don't you google it no it didn't it didn't think I didn't look guys I'm not a special I don't have a stack of books on my shelf about this when I responded to a natural vegans video I googled to get that peer-reviewed article it didn't take long sorry it's not asking that much it's really not yeah I mean I can understand the desire just the natural inclination to accept what authority figures tell you and you know if your doctor says that this is safe for you like if you know this will help you this will help you feel better of course like you you want to trust your doctor and you want to trust Authority you know that people actually have your best and your best right right now like you were your health you know and that's the doc you know that's the hypocrite Hippocratic oath yeah do no harm doctor isn't supposed to hurt you so um you know I can understand when people saw that video you know commenting like well this is what psychiatrists are prescribing like how can you say that this is wrong in doctors tell you eat eggs and bacon yeah there are nutritionists who tell you fish the diabetic Association right and this is this famous example now thanks to that movie the American Dietetic Association encourage you to dairy products which especially for diabetes has this special link it's all but it's bad for you general okay well I mean I saw another misconception saying look peer review is not what you think it is and for me what your comments make me think of just now is that consensus is not what you think it is okay now suppose someone said to you there is a consensus among scientists that eating eggs is healthy okay well let's use a more marginal that eating yogurt is healthy okay Cowell yogurt yeah okay but you can you condemn it in a sense you can demonstrate this consensus I think it's real this is a real misunderstanding of what the word consensus means no but I can respond as false there is no consensus that cholesterol is is healthy there is no consensus that having animal fat in your diet is healthy right there's any way we can get into more but what's wrong with dairy products and affecting your blood sugar who can make a whole list of things here there's there's no consensus that the levels of estrogen in cow milk cow yogurt are healthy that's not a consensus right so now I've pointed to you facts if you're gonna say to me that yogurt is healthy are you actually claiming that cholesterol is something No okay so what does that consensus mean like why in what sense can you don't you think so what's the opposite of consensus it's that something is contested scientifically so actually actually it's contestable and actively contested whether or not people should eat yogurt who thought people should eat should eat eggs and there are medical doctors on both sides we can find reputable medical doctors you know the former head of the American Heart Association so on who do advocate for a vegan diet and again as with Buddhist studies I was I'm a very unusual scholar of Buddhism I'm the guy who's willing to question Oh does this text really mean what everyone's does this philosophy really mean what everyone says it means so I'm the guy who makes that finding honestly it didn't take a genius what it took was detachment right what it took was a kind of analytical distance from your topic where you're not so wrapped up in it that you're going to see what's there and you know question how did we come to this conclusion and this assumption and so on right um how could you possibly say to me that there is a consensus that SSRI drugs are effective when the actual effect has been debunked ie the original thesis and which is still in the name SSRI the thesis was that depression is caused by low serotonin levels and that it's cured by raising your serotonin levels when did you get your serotonin levels checked they don't do that because it is a proven scientific fact that depression does not in any way correspond to at certain levels and that these drugs don't act on the brain in that way their effect is not to raise your serotonin levels and and thus your depression and thus also again this is directly counter not just the the substance of what unnatural being said but also the wording to the letter the substance and the sentiment and the letter this disease-centered theory of depression the idea that you have quote a chemical imbalance in your brain and that that's what depression is that's what a natural began said you that has been debunked so for you to see to me there is consensus above this no there isn't and again if the only peer-reviewed article on the subject is the one I read to you and the first even if that's the only one that shows you that there isn't consensus that there is a contest about the actual evidence base and about the methodology right if if the evidence is wrong or the evidence shows the contrary of the original thesis and the methodology is wrong then that's a problem that can vitiate that can invalidate the findings in 50 articles 100 articles so on and so forth alright so I think that's a wrap for this video we do have other things we can talk about but I think probably so that it gets to that person I think I'm going to talk about that in a separate video and I can talk a little bit more about personal you know stuff related to human history and depression and so on okay but I mean look say this really briefly you know your life has changed dramatically in the last year net -2 you know mine has too I mean the sources of misery in my life have changed you know the struggles I have have changed now it's also true that my attitude towards them has changed and my outlook and my objectives you know things have changed but you know I had a period of about two years where I couldn't see my daughter right where I was cut off from seeing my daughter of course I was incredibly unhappy about this now I'm in a situation where I get to regularly see my daughter on a schedule appointed by a court in France hey we're gonna see her again in about a week now or something you know my life changed I had a pureed world was unemployed then I had a period where I was a university instructor teaching English you know China now I have a period where I'm in college learning how to bake bread these are changes you know the reality of how depressing my life is changes from period of time to time it's also true that my attitude changes and of course it can be a little snide to say to someone oh well you should just change your attitude I think it can also be challenging to say to someone well you should change your actual circumstances you know like if you're unhappy with your marriage maybe you've got to get divorced you know and look at my ultimate that was my situation if you guys don't know I dumped my ex-wife she didn't dump me she didn't you know leave me I made the decision you know to end that relationship these are you know hard hard decisions that people have to make in their lives and you know again it is partly a scientific conclusion and it's partly a philosophical conclusion that I don't believe the use of these drugs long term could possibly possibly help you in making those decisions in making those changes in either your real-world circumstances or your philosophical attitude motivations perspective on them they'll just to come back to this issue effectiveness versus effect in terms of the strength of the effect one of the most powerful drugs in the world to shake you out of depression has got to be cocaine there's no way a meal if you're sad because somebody your family died you're sad because you hate your university you're sad because of your marriage if you did a short course of treatment in cocaine you would be completely jolted out of that depression you may also do brain damage to yourself you may also become an addict you'll definitely ruin your sleep cycle you ruin your your cardiac health you run that with your heart there are a lot of disadvantages using a there are a lot of negative side effects your sex life may get better or it may get worse cocaine also has a big effect on human sexuality but how would we possibly deceive ourselves into thinking even if cocaine is effective short term control Gina how could we deceive ourselves into thinking the problem was that you had a coke efficiency the situation was that this was in any way comparable to a diabetic getting a blood test with their blood sugar levels and needed to augment their insulin to someone with low testosterone get into an assessment level check this is a self-serving myth of the crudest kind for a culture of self medication a culture of people have become accustomed to regarding human unhappiness itself as a disease and ironically the cure that has become so popular for that disease as a proven fact just doesn't work a virus Yin